With a Republican majority in the U.S. House of Representatives and anticipation building in Beijing for a change in leadership in 2012, domestic politics in both countries are playing a major role in the bilateral relationship. On the eve of his own milestone—his 80th birthday—John W. Lewis, one of the world’s foremost China scholars and the director of CISAC's Project on Peace and Cooperation in the Asian-Pacific Region, discussed the direction of the U.S.-China relationship, the importance of dialogue between the two powers, and the potentially rocky road ahead. Excerpts:

CISAC: The conventional wisdom seems to be that relations between the two countries are not very good and getting worse. Can you provide some context?

Lewis: There have been many, many times when the relationship has been worse. The fundamentals in U.S.-China relations, in my view, have over time gradually gotten better. Both sides recognize that there is a complementarity in their relations in the Pacific. There is a kind of synergy that is very important, and when things get bad, as they are now certainly—or not good—both sides try to keep the genie in the bottle. Several things are important: even though the Chinese think we made the Taiwan problem worse with the sale of $6.4 billion worth of advanced weapons, the Cross-Strait relationship is actually pretty good. That ingredient in our relationship with China is not a serious problem. The issues that we have are not abnormal in big power relationships.

What is so sad at this point is that the militaries on both sides—the Pentagon and the People's Liberation Army—they both want to have a serious engagement with each other. They want to have a security relationship with us, but we have these constant issues such as the South China Sea and the Yellow Sea. It changes every day, but now they say they want to put the USS George Washington in the Yellow Sea, or what the Koreans call the West Sea. It's stupid militarily and it's provocative from the Chinese point of view, and you can't defend it other than that the South Koreans want it. And from the Chinese point of view, they cannot imagine why during the calm periods with North Korea, for example, we don’t try to take advantage of that, why we don’t try to make progress in the Six-Party talks. So they see this constant set of problems that project into China that do affect U.S.-China relations. Add into that the political rhetoric in this country, the loss of jobs to China, for instance. It's a big political deal in the United States now. With China, there are endless things we could do. But politically Obama will not do it because he’s going to take a hit domestically. The anger against China is so strong in Washington, and perhaps in the rest of the country, whether it’s because of human rights or questions related to their currency exchange rate. But again, the fundamentals are quite different. They are actually pretty sound.

CISAC: China is gearing up for a major transition of power. How will this affect the relationship?

L: Now that Xi Jinping has been made vice chairman of the Central Military Commission it’s pretty clear that the jockeying is already moving in the direction [that he will succeed President Hu Jintao]. Can something happen? The Chinese always worry, as any politician would, about the next round. So they’re not going to make any mistakes, and they’re not going to do anything that gets themselves off track. They cannot back down [on foreign policy]. No one can back down against the United States or anyone else, particularly now with the Japanese. They’re going to come right at the Japanese.

CISAC: So the transition makes things more difficult?

L: Absolutely, and it’s true in the United States. Obama's looking at the election and he's going to do everything he can to move to the right and look like he’s really tough on all the things the Republicans can hammer him on. That’s going to shape how the Chinese pick their leadership in 2012. Their selection will come at about the same time as ours in 2012—the campaigns will be simultaneous—and it’s too bad. If we become very nationalistic, it’s going to look very hostile to them. And we’re going to be wagged by the Japanese and South Korean dog, and this great power, the United States, is going to look helpless to them. China is offering opportunities to solve problems and we are not prepared to take them, and they're saying, ‘are you not willing to talk to us?’?

In the wake of the global financial crisis, some have dubbed China and the United States the G2, signifying their centrality in global economics and politics. Even so, the relationship between China and the United States is rife with new tensions. Trade and currency challenges persist, complicated by domestic politics and differing approaches to security issues.

In its annual conference to honor the memory of eminent China scholar Michel Oksenberg, Stanford's Shorenstein Asia-Pacific Research Center gathered distinguished policymakers and analysts to examine colliding—and overlapping—interests in U.S.-China relations.

The conference was kicked off by Jeffrey Bader, special assistant to the president and senior director for East Asian Affairs at the National Security Council, who began by exploring the possibility of productive, stable relations amid values that appear to differ vastly. In support of this idea, Bader pointed to successive American presidents, going back to Richard Nixon, who found points of commonality with China. China poses a different challenge today, he argued, than even a decade ago, as its influence has grown alongside its commercial and economic presence. The Obama administration, Bader explained, has sought China's support on key issues and pursued partnership within the context of a broader Asian policy. He concluded by saying that China's rise is not intrinsically incompatible with American interest, but that does not preclude ongoing competition.

A panel chaired by Jean C. Oi, director of the Stanford China Program, next looked at competition and cooperation in the U.S.-China economic relationship. Despite the dangers of speculative bubbles and weakened export markets, the prospects for sustained economic growth in China remain very good, argued Nicholas Lardy, senior fellow at the Peterson Institute for International Economics. Robert Kapp, former president of the U.S.-China Business Council, explored growing challenges facing American business in China, exemplified by recent clashes over Internet censorship. Despite the U.S.-China clash at the Copenhagen global climate conference, Stanford Law Professor Thomas Heller contended that behind the scenes global consensus on this issue has advanced.

Points of tension in the security relationship were the focus of a panel chaired by Amb. Michael H. Armacost, the Shorenstein Distinguished Fellow. China-Taiwan tensions have improved, but Smith College's Steve Goldstein cautioned that Taiwan's policies could shift again, particularly if the promised economic benefits of improved ties do not materialize. China and the United States must likewise manage challenging allies in North Korea and Japan respectively, said Alan Romberg, director of the East Asia Program at the Henry L. Stimson Center. Finally, the United States and China have both congruent and conflicting interests at stake in dealing with the situations in Iran and Pakistan, Stanford's Thomas Fingar, the Oksenberg/Rohlen Distinguished Fellow at FSI, told the gathering.

The United States and the ASEAN group of nations have further strengthened political, economic and security ties, after their second full-scale summit in New York.

President Barack Obama said the Association of Southeast Asian Nations, which groups ten countries, had the potential for true world leadership. President Obama also made it clear that he saw Asia as a vital plank of US foreign policy.

DR EMMERSON: In the run-up to the summit, there was a big question. Would the partnership be declared as being strategic in nature? That was a key word in the discussion and what happened was the leaders basically finessed the issue. It's not hard to suspect that they worried that if they declared a strategic partnership with the United States, this would cause alarm in Beijing. Because let's remember in the run-up to this summit, we've had a lot of activity - the split between China and Japan over the disputed islands, one could continue with some evidence of a more muscular Chinese foreign policy, its commitment to its claim to possess basically the entire South China Sea, escalating that to the level of a core interest, presumably equivalent to their interest in recovering Taiwan. I could go on, but in many case, it was understandable that the subtext of the meeting was what will China think? So basically what the summit did was to finesse the issue. They decided to pass on the question of raising the partnership to quote - a strategic level - unquote, to the ASEAN US Eminent Persons Group, presumably expert advisors that would be convened and would make recommendations down the road.

And one of the most remarkable things about the statement was how much ground it covered. I mean, among the topics and issues that the leaders committed themselves to do something about, were 14 as I count them, 14 different subjects. Human rights, educational change, trade and investment, science, technology, climate change, interfaith dialogue, disaster management, illicit trafficking, international terrorism, I could go on. So it is clear to me that one of the tasks that ASEAN and the US will have to face in the coming months, is to try to insert some sense of priority.

LAM: On that issue of priority, the US President, Barack Obama, of course, postponed a couple of visits to Indonesia due to pressing domestic demands. Did he in anyway express American commitment to the ASEAN region?

DR EMMERSON: Yes, this was particularly kind of, I suppose you could say, evident in the fact that the meeting occurred at all, finally it was organized. It lasted two hours. He was apparently quite engaged and engaging during that period of time. And I think there is no question that the United States under his administration is committed to South East Asia as a region, indeed has agreed with the leaders of ASEAN, that ASEAN should play a central role in the process of building regional cooperation in East Asia.

LAM: And, of course, one of the topics that came up as well was the South China Sea, that entire region, given the competing maritime and territorial claims vis-à-vis the Spratley and Paracel Island groups. Do you think China is watching the US relationship with ASEAN, this growing relationship - do you think Beijing might be watching it with unease?

DR EMMERSON: Yes, absolutely. I am confident that they are watching it with considerable unease and I note that the statement that the leaders made, made no reference whatsoever to the South China Sea, presumably because of sensitivity with regard to Beijing's possible reaction. The topic was implicitly mentioned, but not explicitly.

LAM: And what about within ASEAN, the grouping itself? The UN Secretary-General, Ban Ki-moon, on the weekend said that the ASEAN nations' credibility might suffer if they did not take a tougher line with Burma and this is in view of the upcoming elections in November. This is presumably directed at specifically China and India, but it could also be referenced to ASEAN could it not, because Burma is a member of ASEAN. Do you see that changing anytime soon with ASEAN, that ASEAN countries, leading members like Indonesia, Malaysia, Singapore, that they might take a stronger stand with the military junta in Rangoon?

DR EMMERSON: The election in Myanmar, if I can call it an election, since it will be highly compromised and manipulated will take place, at least is scheduled to take place November 7th. Indonesia does not take over the chairmanship of ASEAN until the 1st January. So the question is, since Indonesia is a democratic country, arguably, the most democratic of any country in South East Asia, will it use its opportunity to try to put pressure on Burma in the year 2011? My own view is that ASEAN will probably not fulfill Ban Ki-moon's hope, will not exercise significant pressure on the junta. Instead, we could get the opposite situation in which so long as there is not major violence associated with the election, it will essentially be received by ASEAN as a kind of minimally-acceptable basis for assuring the Burmese junta that ASEAN still treats them as a full member. In other words, it's quite possible that the junta may get away with what I take to be a kind of facade effort to legitimate their rule.

Malpractice liability, along with medical technology and payment system distortions, regularly figures among the most-cited reasons for escalating health-care spending in the United States. On the one hand, Harvard economist Amitabh Chandra conservatively estimates that upwards of $60 billion, or 3 percent of total health care costs ($1.8 trillion), is spent annually as a result of direct litigation and indi­rect defensive medicine costs. On the other hand, tort reform advocates place the figure at $200 billion by extrapolating, to the entire U.S. population, the results of research conducted by Stanford professor Dan Kessler and Mark McClellan. Their 1996 study shows that tort reforms reduced provider liability costs for Medicare heart patients by 5 to 9 percent.

At the heart of these debates is the following question. Does medical malpractice liability achieve its dual goal of compensating victims of medical injuries and deterring medical errors, or does it merely encourage wasteful defensive medicine without improving patient health? Despite considerable empiri­cal research, there is little evidence that malpractice litigation deters medical negligence. The evidence is much stronger—though still hotly debated—that malpractice fears actually encourage physicians to engage in defensive medicine.

The newest release in the Asia health Policy Program working paper series, AHPP working paper #13 by Brian Chen, explores whether malpractice pressures affect physician behavior, patient health, and health care costs in Asia. Studying physicians’ response to legal changes in Taiwan, he finds that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Chen investigates how physicians’ test-ordering behavior and propensity to perform cesarean sections were affected first by a series of court rulings in Taiwan that increased physicians’ liability risks, and then by a subsequent amendment to the law that reversed the courts’ rulings. He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected but unexpectedly reduced cesarean sections. The reduction in cesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings. After the law was amended to negate the court decisions, physicians reversed their previous behavior, reducing laboratory tests and increasing cesarean deliveries. This pattern of behavior strongly suggests that physicians in Taiwan practice defensive medicine.