Indo-Pacific nations are racing to adapt to a world in which the United States has become fundamentally unpredictable. The 2026 Oksenberg Conference, hosted by the Shorenstein Asia-Pacific Research Center (APARC), gathered scholars and foreign service veterans at Stanford University to assess how regional stakeholders are confronting what Canada's Prime Minister Mark Carney had famously named "a rupture, not a transition" in the post-World War II order. The conference took place as Carney was in the midst of an Indo-Pacific trip, visiting Australia, India, and Japan to forge "middle power" trade alliances, and as the United States joined Israel in a war against Iran.

“For Indo-Pacific countries, the question is no longer just how to balance between Washington and Beijing,” said APARC Director Kiyoteru Tsutsui in his welcome remarks, “but how to understand and respond to the emergence of a multipolar world in which the United States is less predictable, less committed to multilateral frameworks, less invested in alliance maintenance, and more willing to pursue narrowly defined national interests at the expense of broader international stability.”

The panelists agreed that, while the U.S. retreat from the eight-decade-old international order it had previously championed creates multiple opportunities for China, Beijing is not naturally filling the vacuum, and regional powers are not pivoting toward it but instead scrambling to diversify security and economic partnerships. The consensus is that the international system is moving toward multipolarity and the world toward an increasingly unstable period, and no one knows yet what will replace the disintegrating post-WWII order.

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China Sees Opportunity in Multipolarity

To commemorate the legacy of the late Michel Oksenberg, a renowned scholar of contemporary China and a pioneer of U.S.-Asia engagement, the Oksenberg Conference, an annual tradition sponsored by APARC and led by the center’s China Program, gathers individuals who have advanced U.S.-Asia dialogue to examine pressing issues affecting China, U.S.-China relations, and broader U.S. Asia policy.

At this year’s convening, the first panel, moderated by Shorenstein APARC Fellow Thomas Fingar, focused on how China perceives, interprets, and responds to the new vulnerabilities and opportunities in the international system.

Speaking via video link from Beijing, Da Wei, a professor in the Department of International Relations at Tsinghua University and the director of its Center for International Security and Strategy, said China views the current moment as neither ideal nor catastrophic but better than recent alternatives.

China has experienced three scenarios, Da explained. First, from the 1990s through the Obama era, China benefited greatly from the U.S.-led liberal order, but was increasingly criticized by the West. Second, during Trump's first term and the Biden administration, while facing mounting pressure of decoupling in a bipolar system, China was forced into a camp with Russia, which Da characterized as Beijing’s “worst scenario.” Now, under Trump's second term, the shift toward multipolarity has redirected pressure away from China and onto multilateral institutions and U.S. allies – "the least bad option" from Beijing’s perspective.

Da argued that “culturally, China has a very low appetite for global governance or leadership.” China sees itself primarily as a regional power, he said. Rather than filling the vacuum left by the U.S. withdrawal from international institutions, "we want to be powerful and respected in the region. I don't think China has a very big appetite for leadership in faraway regions, except for economic interests." He contrasted this “Emperor's perspective,” demonstrated by China’s foreign policy, with the U.S. “boss perspective.”

Susan Shirk, a research professor at the University of California, San Diego’s School of Global Policy and Strategy and director emeritus of its 21st Century China Center, noted that China's response to Trump's trade war has been robust, muscular, but disciplined. "The Xi Jinping administration was operating in a more disciplined manner than it had previously," she said, contrasting this approach with what she called Xi's "rash reactions” to Japan and failure to engage Taiwan diplomatically.

Shirk stated that, while Trump's alienation of U.S. allies through extreme tariffs and military interventions has created clear opportunities for China to expand its influence and further divide Washington from Europe and Asian partners, Beijing has only modestly exploited these openings.

She emphasized that Xi's support for Russia in its war against Ukraine represents "self-defeating overreach" that undermines China's ability to improve relations with Europe. "Russia represents an existential threat to Europe," she said. "Xi Jinping really doesn't grasp how important this is."

Mark Lambert, a recently retired U.S. State Department official who served as China coordinator and deputy assistant secretary in the Bureau of East Asia and Pacific Affairs, contrasted the Biden administration's China strategy with the current U.S. policy vacuum.

The Biden approach, he explained, was rooted in U.S. relations with five Asian treaty allies plus NATO and positioned China as the only country with the means and capabilities to reshape the post-World War II order. It required "all hands on deck" to address this challenge through what U.S. officials called a "lattice work of relations": the Quad involving India, AUKUS with Australia, the Camp David summit between South Korea and Japan, and strengthened linkages between NATO allies and East Asian partners. China's support for Russia's invasion of Ukraine unified Europeans in understanding the China challenge in ways never seen before. The administration also successfully reframed Taiwan's importance, emphasizing that Taiwan's chip dominance was vital to global prosperity.

Today, Lambert argued, the United States either has no China strategy or “one so classified that neither our allies nor our practitioners know what it is.” On security, trade, technology, and international cooperation, the United States has given China “fantastic opportunities,” he noted.

Allies’ Transactional Coping Strategies

The second panel, moderated by Laura Stone, a retired U.S. ambassador and APARC's inaugural China Policy Fellow, turned to other regional states – South Korea, Japan, Russia, and India – and how they read the geopolitical landscape and devise strategies to shape the regional order.

Victor Cha, the D.S. Song-KF Chair and professor of government at Georgetown University and president of the Geopolitics and Foreign Policy Department at the Center for Strategic and International Studies (CSIS), noted that "every U.S. ally around the world is looking at a Plan B," pointing out that, in the first year of the second Trump administration, allies were not acting on these plans, but that "we’re now at a threshold where many of them are executing their Plan B's."

Cha identified seven types of behavior that U.S. partners have adopted when dealing with the Trump administration. These are drawn from a recent CSIS project on ally and partner responses to the paradigm shift in U.S. foreign policy. First is prioritizing face-to-face meetings with Trump himself, "because there's a recognition that the policy process in the United States is broken,” Cha said, “and that policy making is not being informed, as it traditionally has been, by foreign policy professionals. It's all happening at the leader level."

Other strategies include minimizing risk to avoid what Cha called "the Zelensky moment" – the public humiliation Ukraine's president suffered in the Oval Office in February 2025 – and preparing "trophy deliverables," such as South Korea's promise to buy Boeing airplanes and Japan's commitment to purchase Ford trucks.

“The America First policies have effectively put the custodial burden of maintaining the alliance on the partner,” Cha said. “Whether it's Japan, Korea, Taiwan, the Philippines, or whoever it might be, the burden traditionally has been on the United States, but now it's on the partner. They're the ones who have to try to maintain this relationship. So it's about minimizing risk.” 

South Korea's recent summit with Trump yielded a $350 billion investment package, yet soon after, U.S. immigration authorities raided a Hyundai facility, and Trump threatened 25% tariffs on Korea.

"Why take all this abuse?" Cha asked. His answer: South Korea and Japan see no alternative to the United States on security, and they secured previous concessions in areas such as nuclear submarines, ship building, and enrichment and reprocessing of spent nuclear fuel, which they do not want to renegotiate. 

One positive outcome, Cha pointed out, has been the unexpectedly warm bilateral relationship between Japan and Korea. Despite having leaders who would normally clash – a far-right conservative in Japan and a progressive in South Korea – the uncertain geopolitical environment has brought the two countries together.

He predicted China would eventually use economic coercion against South Korea over the U.S.-Korea nuclear submarine agreement, just as it did during the 2016-17 THAAD dispute and is currently doing to Japan. "It's not happening now because I don't think China wants bad relations with Japan and Korea at the same time, but it's coming," he said, adding that this development will likely push South Korea closer to the United States and Japan.

Japan Reconsiders Alliance Dependence as Its "Too Big to Fail" Status Proves No Shield

Katherine Monahan, a 2025-26 visiting scholar and Japan Program Fellow at APARC and a foreign service officer with the U.S. Department of State, said Japan's relationship with the United States is "too big to fail," but that has not prevented serious strain between the two allies.

Having served in Tokyo as deputy chief of mission at the U.S. Embassy in Japan until April 2025, Monahan shared that, when Trump's Liberation Day tariffs hit Japan with a 25% rate, the Japanese could not believe that was the figure next to their name, while other allies were at 20% and 15%. They wondered, “Don't we have any special relationship at all?”

Monahan called attention to a recent Foreign Affairs article by Masataka Okano, Japan's former national security advisor, in which he argues that Japan needs to take strategic autonomy more seriously. When made by a former Japanese official, such a statement represents a significant shift in the nation’s mindset, she said. 

Japan is also reconsidering previously used language around "de-risking" from China in favor of diversifying trade with multiple partners, including China, Canada, and Europe. This shift is happening on the backdrop of the current war with Iran, as 90% of Japanese oil comes through the Strait of Hormuz. “Japan has to start balancing sources and supply chains,” Monahan argued.

Russia Exploits American Unreliability

Russia expert Kathryn Stoner, the Satre Family Senior Fellow at Stanford’s Freeman Spogli Institute for International Studies, said America’s unpredictability under Trump represents pure opportunity for Vladimir Putin.

"Putin knows Trump. He gets him," Stoner said. "They have a not-completely dissimilar worldview." Trump's red carpet welcome for Putin at last year's Alaska summit, despite the Russian leader's indictment by the International Criminal Court for war crimes, sent a powerful message, Stoner asserted. So did Trump's lack of concern for democratic values and his criticism of U.S. allies.

She reminded the audience that Putin has been in power for 26 years and has watched multiple U.S. presidents come and go, adapting successfully to each. Putin wants multipolarity, she said, and Trump’s actions have emboldened him. Putin’s goal is to “reclaim Imperial Russia as a global power and restore what he views as its proper sphere of influence,” extending through Ukraine and Belarus into Poland, up to German borders in the west and to the south, through Moldova, Serbia and Bulgaria, to the Black Sea in the east, all the way to the Kamchatka Peninsula. 

According to Stoner, the Russia-China relationship is significantly more durable than many believe. The relationship between the two powers extends beyond oil sales to investment, defense coordination, and sophisticated military exercises. “It kind of doesn't matter whether there's love lost or not. There's an opportunity to be gained on both sides."

"Russia's economy is actually not on the verge of collapse," Stoner added. "It has completely retooled toward the military."

India Feels Betrayed

Emily Tallo, a postdoctoral fellow at Stanford’s Center for International Security and Cooperation, who studies how political elites structure foreign policy debates in democratic countries, especially in India, explained that New Delhi felt especially betrayed by Trump's foreign policy pivot.

The first Trump administration had centered India as a key partner against China. In May 2025, however, when an India-Pakistan conflict flared up, Trump claimed credit for brokering peace, but India took issue with his threat of trade measures to bring an end to the conflict. He then hosted Pakistan's army chief at the White House and signed deals with Islamabad. "This was a twist of the knife for India," Tallo said.

Trump also imposed 50% tariffs on India, including a penalty for buying Russian crude oil, which was not applied to China, and backed out of a QUAD summit in New Delhi.

India now views China as its primary security threat, and the recent India-Pakistan crisis, in which China supplied all of Pakistan's weapon systems and possibly intelligence, made New Delhi’s two-front threat fears a reality. "India is really sensitive to any hints of U.S. retreat in the Indo-Pacific, and any acceptance of Chinese Hegemony in the region," according to Tallo.

She concluded that, like other regional powers, India is committed to preserving the U.S. partnership but is diversifying and seeking a “Plan B.” It finalized free trade agreements with the European Union and the United Kingdom, agreed to purchase French Dassault Rafale jets, and conducted a pragmatic reset with China, citing U.S. unreliability as cover to stabilize a difficult bilateral relationship.

“India wants to be a regional power aligned with but not allied with the United States [...] They want to be considered as the United States’ main partner in Asia and a major counterbalance to China.”

Headlines about foreign companies establishing a foothold in China only to fail years later no longer surprise anyone. But why does this keep happening? Kenneth Wilcox, former CEO of Silicon Valley Bank (SVB) from 2001 to 2010 and author of The China Business Conundrum: Ensure that Win-Win Doesn't Mean Western Companies Lose Twice, argues that the answer comes down to mental models and preparation.

In a recent lecture hosted by the Stanford Center on China's Economy and Institutions, Wilcox explained that we all develop mental models — internal frameworks that help us interpret and navigate the world around us. We carry these models with us wherever we go, applying them instinctively to new situations and environments. The trouble, Wilcox argues, is that a mental model only holds up if the new environment resembles the one it was built for. And American mental models, more often than not, simply don't hold up in China.

Wilcox knows this firsthand. After a decade leading SVB, he and his wife moved to China in 2011 to open a Chinese branch of the bank. Things started smoothly enough — he secured a partnership with Shanghai Pudong Development Bank and obtained the necessary license — but it quickly became clear that the rules he'd spent his career following no longer applied. The license, for instance, permitted him to open the bank but barred him from conducting any business in renminbi, China's national currency, for the first three years. For a bank, this created an obvious problem: how do you pay staff, let alone operate, without access to local currency? The government's solution was a subsidy to cover operating costs during that period, along with an invitation to meet regularly with other banks and business leaders to share SVB's model and approach. After many such meetings, Wilcox's Chinese partners told him they had been so impressed with what they'd learned that they planned to open their own bank modeled on SVB's approach.

This, Wilcox explained, is a pattern that plays out with striking regularity in China. Foreign companies are lured in with the promise of a vast new market and eager local partners. They are then entangled in regulations and bureaucracy, kept afloat with subsidies while they wait for permission to operate more freely — all while their technology and intellectual property are quietly absorbed. Eventually, the foreign company is left with little choice but to close up and leave. Some companies see it happening but look the other way. Others don't recognize it until it's too late. Many never fully understand why they failed at all.

Wilcox traced all of this back to the limitations of mental models. American businesses tend to arrive in China assuming the environment will function more or less like home: keep your head down, stay out of politics, focus on the business, and you'll be fine. But that assumption doesn't hold in China, where the government and the Communist Party exert control over virtually every aspect of commercial life. The most powerful players routinely hold simultaneous roles — party member, bank executive, government official — all at once. It is precisely these unexamined assumptions, Wilcox concluded, that set so many Western ventures up to fail before they've even begun.

Despite advances in healthcare delivery, access to high-quality medical care remains uneven in many countries. In systems where medical resources are limited and physician quality varies widely, patients must make important decisions about where and from whom to seek care. These choices can shape not only individual health outcomes but also the efficiency of healthcare systems.

Yuli Xu, a postdoctoral fellow at APARC’s Asia Health Policy Program, has made these questions central to her research on how institutional structures shape individual behavior and inequality in labor and health markets in both China and the United States. “I examine how policy reforms and institutional arrangements influence outcomes for families, workers, and patients, using large administrative and survey datasets,” she says

At a recent webinar, Xu presented new research examining patients’ preferences for physician continuity in China’s healthcare system. Her work explores whether patients prefer to return to the same physician even when institutional barriers to switching providers are minimal.

Watch her talk on our YouTube channel.
 

Physician Continuity in a Flexible Healthcare System

Much of the existing research on physician continuity focuses on healthcare systems in developed countries, where institutional rules strongly shape patient behavior. In those settings, referral requirements, insurance networks, and primary care gatekeeping often limit patients’ ability to switch doctors easily.

China’s healthcare system offers a very different context. “My interest in this topic was initially motivated by observing the stark differences between healthcare systems in China and the United States,” Xu says.

“In China, patients can often choose doctors directly with relatively few formal barriers, while high-quality medical resources remain scarce,” she explains. “This contrast made me interested in understanding how patients value continuity of care in a setting with fewer institutional switching frictions but greater variation in physician quality.”

Patients in China can often select physicians directly through hospital appointment systems and may visit specialists without referrals. This flexibility allows researchers to observe patient preferences more clearly, since continuity with a physician is less likely to be driven by institutional constraints.

Xu’s study draws on administrative medical claims data from residents enrolled in China’s Urban and Rural Resident Basic Medical Insurance program. The dataset includes detailed information on outpatient visits, diagnoses, expenditures, and physician identifiers. These records make it possible to track how patients choose physicians over time and whether they repeatedly return to the same doctor.

Evidence of Persistent Physician Choice

Xu’s first question is whether patients maintain consistent relationships with physicians when switching is easy. The data show that many do. Patients with chronic conditions frequently return to the same physician over multiple visits, suggesting that continuity of care remains an important factor in medical decision-making.

To analyze physician choice more systematically, Xu estimates a discrete choice model that examines how patients weigh factors such as physician experience, consultation fees, and prior interactions with the doctor.

The results reveal that prior relationships strongly influence patient decisions. Patients are significantly more likely to return to physicians they have visited in the previous six months.

The study also finds variation in preferences across patient groups. Female patients and patients with lower socioeconomic status are more likely to maintain long-term relationships with physicians. At the same time, patients respond to financial incentives. Higher consultation fees reduce the probability of selecting a physician.

These findings suggest that even in a flexible system where patients can easily switch providers, many still value stable relationships with physicians.

To estimate the causal value of physician continuity, Xu examines what happens when these patient-physician relationships are unexpectedly interrupted.

The results show clear behavioral changes. When their regular physician is absent, patients reduce visits to that department and spend less on medical care. The decline extends beyond the physician’s own department. Patients also reduce visits to other departments within the same hospital.

This pattern suggests that many patients organize multiple appointments during a single hospital visit. If a trusted physician is unavailable, patients may delay or cancel other appointments. The study also finds little evidence that patients compensate by seeking care at other hospitals. Instead, many appear to postpone care until their regular physician returns.

Implications for Healthcare Utilization and Policy

By examining how patients navigate healthcare systems with limited resources and flexible provider choice, Xu’s research offers new insights into how institutional design shapes healthcare access and efficiency.

While Xu finds no evidence of worsening short-term health outcomes within months after physicians’ absence, the research indicates that physician continuity can reduce costs for certain patients. Individuals with more severe conditions incur higher medical spending when they must see unfamiliar physicians, suggesting that established relationships may improve efficiency by facilitating information sharing and familiarity with medical histories.

“One strand of my work during my postdoc focuses on the Chinese healthcare system, where medical resources, especially high-quality physicians, are scarce and unevenly distributed,” Xu notes.

Her findings highlight the importance of stable patient-physician relationships in healthcare systems where provider quality varies. Even when patients have the freedom to choose among providers, many still demonstrate strong preferences for continuity with trusted physicians.

Research Community and Future Directions

Xu says her time at APARC has played an important role in advancing this research. “My time at APARC has provided an incredibly supportive and stimulating research environment,” she says. She credits the guidance of Karen Eggleston, director of the Asia Health Policy Program, whose expertise in health economics and Asian health systems helped shape the project.

She also highlights the broader intellectual community at Stanford. “I have had the opportunity to connect with many wonderful scholars across the Freeman Spogli Institute and Stanford more broadly,” Xu says, noting that conversations with economists and health policy researchers have helped refine her work and expand her perspective on healthcare systems.

Looking ahead, Xu plans to continue studying healthcare systems across different institutional settings. “I would encourage young scholars not to focus on only one country, but instead to study broader research questions and examine how they play out across different institutional settings,” she says. “Comparing institutions across countries can generate new insights and help identify mechanisms that might not be visible in a single context.”
 

Key Takeaways
 

• Patients in China demonstrate strong preferences for continuity with physicians despite minimal institutional barriers to switching providers.

• Physician absences lead to significant reductions in healthcare utilization within the same department and across other departments in the same hospital.

• Patients do not substitute toward other hospitals when their regular physician is unavailable, and many return to their original physician once they resume practice.

• The findings suggest that stable patient-physician relationships can improve efficiency and reduce costs in healthcare systems with flexible provider choice.