As healthcare costs for patients with non-communicable diseases such as diabetes have risen, governments and healthcare providers have sought creative measures to align financial incentives with better patient outcomes. One incentive payment system known as “pay-for-performance” (P4P), in which providers are beholden to metric-driven outcomes, represents a potential path forward for healthcare providers to improve healthcare processes, resulting in higher quality and better patient health outcomes. The evidence on the effectiveness of P4P programs, however, is mixed.

To address this uncertainty, a new study, published in The European Journal of Healthcare Economics, assesses the effectiveness, in monetary terms, of a P4P program for patients with diabetes at a hospital system in Taiwan. 

The study coauthors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, employed new patient-level data on clinical indicators, utilization, and expenditures, combined with data from the national death registry, to better understand the costs and benefits of the P4P program. Their results show that Taiwan’s implementation of the P4P program for diabetic care yielded positive results in terms of net value, defined as the value of life years gained minus the cost of care.

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Assessing Net Value of Taiwan’s P4P

Taiwan’s Bureau of National Health Insurance (now National Health Insurance Administration) introduced P4P in 2001 and enhanced the program in 2006 with an incentive for pay-for-reporting of outcomes. Financial incentives were used to encourage continuity of care with metrics such as new patient enrollment, follow-up visits, and annual reports, each tied to a specific monetary value. The program’s features are common across P4P, so the study’s findings have implications in other settings that incorporate similar designs in their P4P programs.

The study compares two different groups of patients at a large regional hospital in Taiwan, one consisting of newly enrolled P4P patients and another using P4P patients who have been enrolled since the beginning of the program. The researchers leverage detailed clinical data not used in previous assessments of the P4P program to better identify both costs and longer-term clinical outcomes based on measured biomarkers and predicted mortality.

Using an economic cost-benefit analysis conducted from a budgetary perspective, the study is the first analysis of any P4P program that estimates changes in the quality-adjusted price index relative to usual care. The authors consider health benefits in terms of survival and predicted survival and convert them into monetary terms. This net value approach is especially useful for policymakers and healthcare administrators who implement value-based purchasing and monitor outcomes for any service delivery innovation over time.

The study finds that Taiwan’s P4P program provided a positive net value for payers and patients, ranging from $40,084 USD to $348,717 USD. These positive net value results are primarily derived from health outcomes as measured by lower mortality rates in the P4P versus non-P4P cohorts, across both newly enrolled and continuously enrolled groups of patients. According to the authors, “these encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.” 

 This study develops a new model for assessing the net value of service delivery innovations like P4P programs that can be applied in other contexts globally, providing healthcare systems researchers with new tools to better understand an emergent option for incentivized care. With a more economically-translatable understanding of P4P programs, this research helps build the bridge between the oft-disparate worlds of healthcare and policy.

This commentary originally appeared in The Economist.

But even with all these improvements, it is unclear whether China could take Taiwan by force. China has not fought a war since 1979, when it made heavy weather of a “punitive” invasion of Vietnam. An amphibious attack, and to a lesser degree a blockade of the type the exercises off Taiwan were simulating, would demand complex joint operations (involving army, air force and navy), which in turn require impeccable logistics and command and control. Xi Jinping, China’s leader, launched a massive organizational reform to improve in these areas, and the PLA undoubtedly has. But the war in Ukraine may have given him heightened anxiety, given that the Russians struggled precisely with logistics and command.

For this reason, we should see the massive exercises off Taiwan less as a signal, and more as a rehearsal for combat. Mr Xi wants progress on the Taiwan issue, and domestically talk in the press is shifting from peaceful reunification to armed reunification. Chinese leaders knew the PLA had to conduct a series of large, realistic exercises to identify issues and hone their capabilities. If China had done so out of the blue, instead of using Ms Pelosi’s visit as a pretext, international opprobrium would have been stronger.

China will seize the opportunity to practice as much as possible. It has announced already that this round of exercises will continue and that another round in the Bohai Gulf/Yellow Sea is next. And it won’t just be large-scale exercises. It is unlikely that Beijing will return to its previous level of operations. Instead, China might attempt to normalize greater Chinese activity around Taiwan. That makes war more probable. Through a series of exercises the PLA, and the party leadership, might gain confidence that China’s forces are ready to take Taiwan sooner than they would otherwise have thought.

Of course, this all depends on how the exercises and operations go. From the outside, this is hard to assess. The missiles landed where they should have in recent days, and there were no accidents. But we don’t know how much and how well different groups are communicating with each other. To prepare for joint operations, air-force units need to operate in close proximity and coordinate with ground troops and amphibious elements. The PLA needs to practice providing supplies, such as prepositioned fuel stocks, and bringing munitions and medical supplies to forward locations such as Fujian, the province directly across the Taiwan Strait.

This is where the real trouble lies. If activities in the vicinity of Taiwan become more routine, not only does this heighten anxiety in Taipei (and probably other regional capitals as well) but it helps to disguise any preparations for a real military campaign. China needs an element of surprise to be able to take Taiwan before America has time to mobilize adequate forces in the region to defend the island. If China’s forces are simulating formations, blockades, attacks, and amphibious landings, it will be harder to decipher when they are preparing for the real thing. Ms Pelosi’s visit has allowed Beijing to move to a new level of military activity unchallenged, which will make it harder for America to defend Taiwan. No signal of America’s commitment to the island can fix that.

This commentary first appeared in Foreign Policy.

Russia’s invasion of Ukraine has been a double disaster for President Vladimir Putin, as he faces a poorly performing military combined with an inability to shield his country from economic punishment. Both of these possibilities historically have also been sources of apprehension for the Chinese Communist Party (CCP). But China’s leadership turned its anxiety into action about 10 years ago, deliberately working to fix many of the problems and minimize the risks currently plaguing Russia in Ukraine.

One result is that the Chinese military is more likely to perform well even though it has not fought a war since 1979, when it lost thousands of troops in a punitive but brief invasion of Vietnam. Adding to that, China’s economy is both far larger and deliberately more diversified than Russia’s. A sanctions effort like the one presently aimed at Russia would be much harder to sustain against China. These two observations do not mean deterrence won’t hold, only that the unfolding events in Ukraine will likely do little to make Beijing more cautious.

Nearly everyone overestimated Russia’s military capabilities—including probably Putin himself. During its invasion of Ukraine, Russia’s air-ground coordination has been ineffective, and Russian forces have shown risk-adverse tendencies in the air. Russia has also struggled with logistics and keeping its military supplied. Notably, it appears that Russia acted on bad intelligence and therefore did not believe initial strikes that maxed out its firepower were necessary. Furthermore, many Russian weapons platforms are outdated (for example, its Cold War-era tanks), and modern Su-57 fighter jets and T-14 Armata tanks only exist in comparatively small numbers.

The Chinese military used to clearly exhibit the same deficiencies. But over the past decade, it has embraced significant reforms, creating a much more capable fighting force that should give even the United States pause.

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First, while Russia allowed its conventional capabilities to atrophy, Chinese military spending has exploded over the past three decades, increasing by 740 percent (in comparison to Russia’s 69 percent) from 1992 to 2017. According to data from the Stockholm International Peace Research Institute, China spent almost four times on its military in 2020 than Russia ($244.9 billion to $66.8 billion). In 1999, less than 2 percent of its fighter jets were fourth-generation, 4 percent of its attack submarines were modern, and none of its surface ships were. Twenty years later, not only did China have much more of everything, but the majority was the most advanced, modern versions available—with China exhibiting advantages over Russia, even in combat aircraft, a traditional area of weakness for China.

Indeed, People’s Liberation Army (PLA) commentators often refer to China’s economic might as one of the reasons their military would outperform Russia’s—Russia has been “stingy” with its military modernization and production of precision-guided munitions primarily because of a lack of resources. By contrast, China has more than 2,200 conventionally armed ballistic and cruise missiles, making the PLA Rocket Force the world’s largest ground-based missile force. Estimates place the number of missiles positioned against Taiwan alone at around 1,000.

Russia’s poor performance does remind us that it takes more than just a lot of fancy systems to win a war (though having more advanced systems and more of them surely would have helped). The human element of Russia’s failures is front and center. Putin probably did not have an open and honest communication channel with the military, which was fearful of providing unfavorable information to the erratic leader. Russian troops were largely considered incompetent, but Putin thought superior technology could overcome human deficiencies.

Chinese President Xi Jinping identified similar training and competency issues in the PLA 10 years ago. But under his command, the PLA has been proactively implementing significant reforms to avoid similar pitfalls. And unlike Putin, who apparently believed technology could overcome deficiencies in personnel, Xi came to the opposite conclusion. When he came to power, he took one look at the military and recognized that with all its fancy equipment, the PLA probably could not fight and win wars and perform the missions it had been assigned. Of particular importance, according to China’s national military strategy, was to fight local wars under informationalized conditions. This meant that the network between platforms and people—the ease of connectivity—was the main feature of modern warfare. China needed the best equipment; an advanced command, control, computers, communication, intelligence, surveillance, and reconnaissance (C4ISR) network; and tons of precision-guided munitions. But perhaps most importantly, it needed troops that could leverage these systems to conduct seamless operations across services and top-down through the chain of command.

What followed was a series of slogans—the two incompatibles, two inabilities, two big gaps, the five incapables—all designed to point out the organizational and personnel issues of the military and focus leadership attention and resources on fixing the issue. A massive military reorganization followed with moves such as reorganizing effective combat units to be smaller so that they can mobilize more quickly and can remain self-sufficient for long periods of time. This means, in contrast with the Russian military, the PLA will likely have less reliance on generals at the front lines. China also established theater commands to facilitate joint operations and prioritized realism in its military exercises to help it prepare for real combat. Part of all of this was Xi’s demand that the military communicate its failures and weaknesses so that they could be addressed. Moreover, to improve command and control, China has moved toward engaging in multidomain joint operations all while standing up a new joint operations center that will ensure that, unlike with the Russian military, orders will be communicated and understood at the lowest levels. Indeed, the main reason that Xi has not yet made a play for Taiwan is likely his desire to hone this command and control structure and practice joint operations in realistic conditions for a few more years—a cautious and pragmatic approach that the situation in Ukraine only encourages further.

The PLA itself acknowledges that it still has some distance to go with training, particularly with regard to joint operations, but it looks as if the hard work is paying off. The complexity and scale of China’s national military exercises are eye-opening. It takes a great deal of planning, synchronization, and coordination to take service-level operations to the joint level. China appears to have made great strides in this area. The United States has observed, for example, China executing deep-attack air operations in its exercises that have combined intelligence, surveillance, and reconnaissance (ISR) with multi-domain strike; lift for rapid mobility and advanced fighter manuevers. Russia has relied heavily on artillery and tanks, now and historically, while the PLA is showing a more balanced approach to combined arms operations.

For all these reasons, we should not expect the Chinese military to perform as poorly in its first real military operation since 1979. The PLA is structurally superior to the Russian military. And the Chinese know it. Granted, it’s hard to know whether some of the outlandish claims in the Chinese media are true—that the PLA Air Force would actually “be able to take out the Ukrainian air force in one hour.” But one thing is for certain—the Chinese military is learning lessons from Ukraine, whether it is to stockpile more precision-guided munitions, ensure solid command and control, or cut off internet access to prevent the leaking of information to the West, which will only serve to improve its warfighting capability in the future.

While China now innovates in many of these technologies, it also continues to acquire Western intellectual property through a coordinated assault that represents what former NSA Director General Keith Alexander calls “the greatest transfer of wealth in human history.” And every technological innovation that China can possibly militarize it does, through a strategy of “civil-military fusion.” With this accumulated power, Beijing plans to force Asia’s most vibrant liberal democracy, Taiwan, to “reunify with the motherland.” It also seeks to establish unilateral Chinese control over the resources and sea lanes of the South China Sea, and then gradually to push the United States out of Asia.

Russia’s aggression must be understood in this broader context of authoritarian coordination and ambition, challenging the values and norms of the liberal international order, compromising the societal (and where possible, governmental) institutions of rival political systems, and portraying Western democracies — and therefore, really, democracy itself — as weak, decadent, ineffectual, and irresolute. In this telling, the democracies of Europe, Asia, and North America — especially the United States — are too commercially driven, too culturally fractured, too riven by internal and alliance divisions, too weak and effeminate, to put up much of a fight.

At the same time, China, Russia, and other autocracies have been denouncing the geopolitical arrogance of the world’s democracies and confidently declaring an end to the era in which democracies could “intervene in the internal affairs of other countries” by raising uncomfortable questions about human rights. 

On the eve of the Beijing Winter Olympics on February 4, Vladimir Putin and Xi Jinping issued a joint statement denouncing Western alliances and declaring that there were no limits to the strategic partnership between their two countries. Many analysts believe Putin told Xi then that he was about to invade Ukraine and that Xi probably said, okay, just wait till the Olympics are over and make it quick. 

Four days after Xi’s closing Olympics fireworks display, Putin launched his own fireworks by invading Ukraine. It has been anything but successful or quick. Xi cannot possibly be pleased by the bloody mess that Putin has made of this, which helps to explain why China twice abstained in crucial UN votes condemning the Russian invasion, rather than join the short list of countries that stood squarely with Russia in voting no: Belarus, Eritrea, Syria, and North Korea. Xi must think that Putin’s shockingly inept and wantonly cruel invasion is giving authoritarianism a bad name.

It is also costing China a lot of money in global trade at a time when China’s economic growth rate has slowed dramatically. And it’s undermining the narrative China was trying to push that the autocracies know what they are doing and represent the wave of the future. Moreover, this is coming at a moment when one of China’s two most important cities, Shanghai, is gripped by panic and a substantial lockdown over the Covid-19 virus, which Xi’s regime has no other means to control except lockdown, because it has refused to admit that the vaccines it developed are largely ineffective against the current strains of Covid, and instead import the vaccines that work.

All of this explains why this moment could represent a possible hinge in history as significant as the 1989-91 period that ended the Cold War. 2021 marked the fifteenth consecutive year of a deepening democratic recession. In both the older democracies of the West and the newer ones of the global South and East, the reputation of democracy has taken a beating. A narrative has been gathering that democracies are corrupt and worn out, lacking in energy, purpose, capacity, and self-confidence. And this has been fed by real-world developments, including the reckless and incompetent US invasion of Iraq, the 2008 financial crisis, steadily rising levels of economic inequality, widespread job losses, economic insecurity and status anxiety due to globalization and technological change, and the challenges of managing cultural diversity amid expanding immigration. These factors have fed or at least facilitated the rise of populist challengers to liberal democracy and the decay of democratic norms and institutions across many democracies — rich, poor, and middle-income. 

The Germans have a word for these trends in the global narrative:  “zeitgeist” — the spirit of the times, or the dominant mood and beliefs of a historical era. In the roughly 75 years since WWII, we have seen five historical periods, each with their own dominant mood. From the mid-1940s to the early 60s, the mood had a strong pro-democracy flavor that went with decolonization. It gave way in the mid-1960s to post-colonial military and executive coups, the polarization and waste of the Vietnam War, and a swing back to realism, with its readiness to embrace dictatorships that took “our side” in the Cold War. Then, third, came a swing back to democracy in southern Europe, Latin America, and East Asia, and a new wave of democracy, from the mid-1970s to around 1990. That period of expanding democracy was then supercharged by a decisively pro-democratic zeitgeist from 1990 to 2005, the so-called unipolar moment in which one liberal democracy, the U.S., predominated. That period ended in the Iraq debacle, and for the last 15 years, we have been in the tightening grip of a democratic recession and a nascent authoritarian zeitgeist. 

Could Russia’s criminal, blundering invasion of Ukraine launch a new wave of democratic progress and a liberal and anti-authoritarian zeitgeist? It could, but it will require the following things.

First, Russia must fail in its bid to conquer and extinguish Ukraine. The United States and NATO must do everything possible, and much more than we are doing now, to arm and assist Ukraine militarily, and to punish Russia financially and economically.

Second, we must wage a more effective and comprehensive battle of information and ideas to expose Russia’s mendacity and criminality and to document its war crimes, not only before the court of public opinion, but in ways that reach individual Russians directly and creatively. We need an intense campaign of technological innovation to circumvent authoritarian censorship and empower Russian, Chinese, and other sources that are trying to report the truth about what is happening and to promote critical thinking and the values of the open society. In general, we need to promote democratic narratives and values much more imaginatively and resourcefully. The message of the Russian debacle in Ukraine is an old one and should not be difficult to tell: autocracies are corrupt and prone to massive policy failures precisely because they suppress scrutiny, independent information, and policy debate. Democracies may not be the swiftest decision makers, but they are over time the most reliable and resilient performers.

Third, we must ensure that we perform more effectively as democracies, and with greater coordination among democracies, to meet the challenges of developing and harnessing new technologies, creating new jobs, and reducing social and economic inequalities.

Fourth, to win the technological race, for example in semiconductors, artificial intelligence, biomedicine, and many other fields of science, engineering, and production, we must open our doors more widely to the best talent from all over, including China. We URGENTLY need immigration reform to facilitate this. As our late colleague George Shultz said:  Admit the best talent from all over the world to our graduate programs in science and engineering, and then staple green cards to their diplomas.

Finally, we have to reform and defend our democracy in the United States so that it can function effectively to address our major domestic and international challenges, and so that American democracy can once again be seen as a model worth emulating. We cannot do this without reforming the current electoral system of "first-past-the-post" voting and low-turnout party primaries, which has become a kind of death spiral of political polarization, distrust, and defection from democratic norms.

I believe we entered a new historical era on Feb 24. What the Ukrainian people have suffered already in these seven weeks has been horrific, and it will get worse. But the courage and tenacity of their struggle should renew our commitment not only to them but also to ourselves—that freedom is worth fighting for, and that democracy, with all its faults, remains the best form of government.

This commentary was originally published by The Wall Street Journal.

A Russian invasion of Ukraine would be the most consequential use of military force in Europe since World War II and could put Moscow in a position to threaten U.S. allies in Europe. Many in the American foreign-policy establishment argue that the appropriate U.S. response to any such invasion is a major American troop deployment to the Continent. This would be a grave mistake.

The U.S. can no longer afford to spread its military across the world. The reason is simple: an increasingly aggressive China, the most powerful state to rise in the international system since the U.S. itself. By some measures, China’s economy is now the world’s largest. And it has built a military to match its economic heft. Twenty-five years ago, the Chinese military was backward and obsolete. But extraordinary increases in Beijing’s defense budget over more than two decades, and top political leaders’ razor-sharp focus, have transformed the People’s Liberation Army into one of the strongest militaries the world has ever seen.

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China’s new military is capable not only of territorial defense but of projecting power. Besides boasting the largest navy in the world by ship count, China enjoys some capabilities, like certain types of hypersonic weapons, that even the U.S. hasn’t developed.

Most urgently, China poses an increasingly imminent threat to Taiwan. Xi Jinping has made clear that his platform of “national rejuvenation” can’t be successful until Taiwan unifies with the mainland—whether it wants to or not. The PLA is growing more confident in its ability to conquer Taiwan even if the U.S. intervenes. Given China’s military and economic strength, China’s leaders reasonably doubt that the U.S. or anyone else would mount a meaningful response to an invasion of Taiwan. To give a sense of his resolve, Mr. Xi warned that any “foreign forces” standing in China’s way would have “their heads . . . bashed bloody against a Great Wall of steel forged by over 1.4 billion Chinese people.”

The U.S. must defend Taiwan to retain its credibility as the leader of a coalition for a free and open Indo-Pacific. From a military perspective, Taiwan is a vital link in the first island chain of the Western Pacific. If Taiwan falls into Chinese hands, the U.S. will find it harder to defend critical allies like Japan and the Philippines, while China will be able to project its naval, air and other forces close to the U.S. and its territories. Taiwan is also an economic dynamo, the ninth-largest U.S. trading partner of goods with a near-monopoly on the most advanced semiconductor technology—to which the U.S. would most certainly lose access after a war.

The Biden administration this month ordered more than 6,000 additional U.S. troops deployed to Eastern Europe, with many more potentially on the way. These deployments would involve major additional uncounted commitments of air, space, naval and logistics forces needed to enable and protect them. These are precisely the kinds of forces needed to defend Taiwan. The critical assets—munitions, top-end aviation, submarines, and intelligence, surveillance and reconnaissance capabilities—that are needed to fight Russia or China are in short supply. For example, stealthy heavy bombers are the crown jewel of U.S. military power, but there are only 20 in the entire Air Force.

The U.S. has no hope of competing with China and ensuring Taiwan’s defense if it is distracted elsewhere. It is a delusion that the U.S. can, as Pentagon press secretary John Kirby said recently, “walk and chew gum at the same time” with respect to Russia and China. Sending more resources to Europe is the definition of getting distracted. Rather than increasing forces in Europe, the U.S. should be moving toward reductions.

There is a viable alternative for Europe’s defense: The Europeans themselves can step up and do more for themselves, especially with regard to conventional arms. This is well within Europe’s capacity, as the combined economic power of the NATO states dwarfs that of Russia. NATO allies spend far more on their militaries than Russia. To aid its European allies, the U.S. can provide various forms of support, including lethal weapons, while continuing to remain committed to NATO’s defense, albeit in a more constrained fashion, by providing high-end and fungible military capabilities. The U.S. can also continue to extend its nuclear deterrent to NATO.

The U.S. should remain committed to NATO’s defense but husband its critical resources for the primary fight in Asia, and Taiwan in particular. Denying China the ability to dominate Asia is more important than anything that happens in Europe. To be blunt: Taiwan is more important than Ukraine. America’s European allies are in a better position to take on Russia than America’s Asian allies are to deal with China. The Chinese can’t be allowed to think that America’s distraction in Ukraine provides them with a window of opportunity to invade Taiwan. The U.S. needs to act accordingly, crisis or not.

Ms. Mastro is a center fellow at the Shorenstein Asia-Pacific Research Center, part of Stanford’s Freeman Spogli Institute for International Studies, and a nonresident senior fellow at the American Enterprise Institute. Mr. Colby is a principal at the Marathon Initiative and author of “The Strategy of Denial: American Defense in an Age of Great Power Conflict.”

In her recent Foreign Affairs essay, The Taiwan Temptation: Why Beijing Might Resort to Force, Center Fellow Oriana Skylar Mastro argues that Chinese leaders now consider a military campaign to take Taiwan a real possibility and cautions that the United States cannot by itself alter Beijing’s calculus on Taiwan. The essay sparked a heated debate. In the September/October issue of Foreign Affairs, several scholars — Rachel Esplin Odell and Eric Heginbotham, Bonny Lin and David Sacks, and Kharis Templeman — provide counterarguments to Mastro's analysis and she responds to their criticism. Read her complete rebuttal below.

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Rachel Esplin Odell and Eric Heginbotham, Bonny Lin and David Sacks, and Kharis Templeman all argue that China is unlikely to attempt armed unification with Taiwan. Although I appreciate their perspectives, they do not present any new evidence that would make me reconsider my assessment that the risk of Chinese aggression across the Taiwan Strait is real and growing. To the contrary, they repeat many of the increasingly dangerous misperceptions that I sought to dispel in my original article—namely, that China does not have the military capabilities to pull off an amphibious invasion, that the economic costs of an invasion would be sufficient to deter Chinese President Xi Jinping, and that China can afford to wait indefinitely to achieve its most important national goal of unification. My critics assume that insofar as there are risks, they can be dealt with through relatively limited adjustments in U.S. policy and military posture — a position with which I still strongly disagree. 

Let’s take these arguments in order. My critics say that I have exaggerated China’s military capabilities and understated the difficulties of an invasion. But their assessments rely on outdated or largely irrelevant comparisons. Odell and Heginbotham, for instance, note that the United States needed more naval tonnage to capture Okinawa from Japan in 1945 than China has today. But this example is inapposite. Japan’s military was more than six million strong in 1945 and had been fighting for over a decade; Taiwan’s military consists of 88,000 personnel and two million reservists, of whom only 300,000 are required to complete even a five-week refresher training course. Tonnage, moreover, is not a useful metric. Modern navies have moved to lighter, more flexible fleets. Odell and Heginbotham point out that civilian ships were of only limited use in the Falklands War, but the United Kingdom used just 62 of them in that campaign. The People’s Armed Forces Maritime Militia has many thousands of ships and is closer to a naval force than a civilian one. If China were to mobilize all its naval vessels, including its new large amphibious transport ships and civilian ships, it could hypothetically carry hundreds of thousands of troops across the 80-mile-wide Taiwan Strait in a short period of time. Even if the United States had enough warning to optimally position its submarines, it does not have enough munitions to target such a large force. 

For their part, Lin and Sacks argue that to believe China can take Taiwan by force is to fall for a Chinese misinformation campaign. They warn that “analysts should not accept at face value China’s claim that it could easily win a fight against Taiwan.” But no one, not even the cockiest of People’s Liberation Army analysts, argues that a full-scale attack on Taiwan would be easy, only that the PLA could prevail at an acceptable cost. Moreover, my assessment of Chinese military capabilities is not based on Chinese discourse or the results of war games alone. Reams of unbiased and rigorous analysis—from the U.S. Department of Defense’s annual report to Congress on China’s military modernization to Congressional Research Service reports on Chinese naval modernization to hundreds of studies by think tanks and defense-affiliated organizations, such as the RAND Corporation—suggest that the PLA has made unparalleled advances in the past two decades and could take on the United States in certain scenarios. Indeed, Heginbotham himself argued in 2017 that “the balance of power between the United States and China may be approaching a series of tipping points, first in contingencies close to the Chinese coast (e.g., Taiwan).” 

I do not mean to suggest that a Chinese invasion would be a cakewalk. Taiwan could get some shots in, but it does not have the ability to defend itself. Luckily, the United States would, I believe, come to Taiwan’s aid and could still prevail in many scenarios. Taiwan is far from a lost cause. But ten years ago, the United States would have prevailed in any scenario. Because there are now some scenarios in which U.S. strategists think the United States could lose, it is not unfathomable to think that Chinese strategists have come to a similar conclusion. 

My critics also argue that economic considerations will deter Beijing. Should China attempt to use force to assert control over Taiwan, the international response would be severe enough to imperil Xi’s ambitious development goals. But as I argued in my original article, Chinese analysts have good reason to think the international response would be weak enough to tolerate. China could even reap economic benefits from controlling Taiwan, whose manufacturers accounted for more than 60 percent of global revenue from semiconductors last year. The United States is heavily reliant on Taiwanese semiconductors. Should China take Taiwan, it could conceivably deprive the United States of this technology and gain an economic and military advantage. 

But economic costs or benefits, while part of Beijing’s calculus, are unlikely to be the determining factor. Xi’s top priority is protecting China’s sovereignty and territorial integrity—as Beijing defines it. China’s Belt and Road Initiative, its militarization of the South China Sea, and its sanctions against countries that offend it, such as Australia or South Korea, all demonstrate that Chinese leaders are willing to subordinate economic considerations to considerations of power and prestige. In a speech marking the 100th anniversary of the Chinese Communist Party in July, Xi warned against foreign attempts to bully or oppress China, declaring that “anyone who dares try to do that will have their heads bashed bloody against the great wall of steel forged by over 1.4 billion Chinese people.” Those words should be taken seriously. 

Finally, my critics argue that China has no need to attempt to forcibly unify with Taiwan. Lin and Sacks think peaceful unification is working; Templeman believes China can wait indefinitely to resolve the issue. I disagree because I think unification is a top priority for the Chinese Communist Party and Taiwan will not give up its autonomy without a fight. 

A Chinese invasion is by no means imminent or inevitable, but Beijing is now seriously considering initiating a conflict to gain political control over Taiwan, whereas in the past the only scenario in which it would have used force was to prevent Taipei from declaring independence. I agree with Templeman that China is unlikely to invade in the next four years (although I think this is largely because China could benefit from more time to prepare, not because it fears U.S. President Joe Biden’s resolve), but his argument that China can wait indefinitely is logically and empirically flawed. As I argued in my original article, Xi has made numerous statements that suggest he wants to achieve unification during his reign. It would be unwise to dismiss these as mere rhetoric, since he has repeatedly voiced his intention to assert control over other territorial claims before doing exactly that — in the South China Sea, by building military infrastructure and conducting naval drills, and in Hong Kong, by imposing a harsh national security law last year.

Templeman argues that if China believes the United States is in decline, then it has every reason to wait on Taiwan. But in the eyes of Chinese strategists, American decline actually hastens the need for action. Power transition theory, which holds that war becomes more likely as the gap between a rising power and an established great power diminishes, is also studied in Beijing. And although U.S. strategists fret that a rising China, dissatisfied with the U.S.-led international order, will become aggressive and start a conflagration, Chinese strategists fear a different pathway to war. They worry that the United States, unable to accept its inevitable decline, will make a dangerous last-ditch effort to hold on to its unrivaled great-power status. By this logic, a declining United States is more dangerous than a stable, ascendant one. 

Lin and Sacks make a different argument for why Beijing does not need to attempt armed unification. They believe that Chinese leaders remain committed to their long-standing approach of limited coercion coupled with economic incentives showcasing the benefits of unification because that strategy is working. As evidence of Beijing’s progress, Lin and Sacks point to polling that shows the majority of people in Taiwan support the status quo, not independence. But it is an enormous leap from not supporting independence to desiring or conceding to unification. As Lin and Sacks themselves acknowledge, China has employed this strategy of limited coercion and economic inducements for decades, but Taiwan is no closer to being a part of mainland China. In a September 2020 poll conducted by National Chengchi University, only six percent of Taiwanese citizens preferred eventual or immediate unification. So although Lin and Sacks are correct that Beijing will likely continue with its carrot-and-stick approach, it will still need to put boots on the ground to gain full political control of Taiwan. 

My critics also raise concerns about some of the policy implications of my argument. Odell and Heginbotham warn against focusing too much on the credibility of the U.S. military threat when it comes to deterrence, rightly highlighting the equal importance of reassurance. They warn that changes in U.S. policy toward Taiwan could convince Beijing that the United States now supports Taiwanese independence — a misperception that could lead to war. But my argument is for a change in posture, not in policy: the United States should develop the force posture and operational plans to deny China its objective in Taiwan and then credibly reveal these new capabilities. It should not make dangerous policy changes that would risk provoking a Chinese military response. Indeed, I have argued elsewhere that even if a war breaks out over Taiwan and the United States wins, Washington should not demand Taiwan’s independence as one of the terms of peace. 

Templeman raises a separate concern: that highlighting the potential costs of defending Taiwan could bolster the case of those advocating that Washington abandon Taipei. If this were a serious worry, I would be the first to shift my work to more private channels. But those calling for the United States to reconsider its commitment to defend Taiwan are still in the minority, and the Biden administration has been clear that it would come to Taiwan’s aid in the event of an invasion.

Moreover, the reaction of the U.S. Department of Defense to the threat posed by China’s growing military power has been not to back down but to ramp up efforts to counter it. From new doctrines that enhance joint capabilities between the U.S. Air Force and the U.S. Navy to base-resilience initiatives to efforts to improve U.S. early warning systems in the region, the Pentagon is firing on all cylinders to ensure it can deter and, if necessary, defeat China in a wide range of conflict scenarios. U.S. Cyber Command, the U.S. Space Force, and the Department of Defense’s Joint Artificial Intelligence Center were all established partly to counter Chinese advantages in those organizations’ respective domains. If Lin and Sacks are correct that China exaggerates its capabilities to try to convince the United States to give up, Beijing has achieved the opposite.   

In the end, all my critics highlight an important truth: the situation across the Taiwan Strait has been relatively stable for 70 years because of the United States. Washington has managed to convince Beijing that armed unification would fail and that China would pay a hefty price for trying. But China is not the same country it was 70 years ago. Its rapid military modernization, spectacular economic ascent, and growing global influence have changed Beijing’s calculus on many issues. It has taken a more assertive approach to international institutions; built one of the world’s largest, most capable militaries; and extended its economic influence deep and far throughout the world. It would be wishful thinking to assume that China has not also changed its thinking on Taiwan.

Indeed, although my critics argue that China is unlikely to invade, they still recommend that Taiwan improve its defenses and that the United States enhance its military posture in the region — not exactly a vote of confidence in Beijing’s restraint. I had hoped to convince skeptics that China is now seriously considering armed unification, but at least our debate has yielded a consensus that more must be done in Taipei and Washington to enhance deterrence across the Taiwan Strait.

Space strategy is central to great-power competition and China believes it needs to excel and compete effectively in space, whether in civilian, commercial, or military usage, says Center Fellow Oriana Skylar Mastro on Space Strategy, a podcast from the American Foreign Policy Council (AFPC). Listen below:

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Mastro joined podcast host Peter Garretson, Senior Fellow in Defense Studies at AFPC, to examine how China views space and why space is key to any military conflict, particularly across the Taiwan strait.

The U.S. military is far superior to the Chinese, says Mastro, yet one main reason China might prevail in a conflict over Taiwan is that it might achieve its goals before the United States can amass enough forces to respond. “Whether the United States can do this is largely dependent on space."

During this conversation, Mastro discusses China's approach to negotiation, deterrence, diplomacy, and inducements; the potential for misunderstanding and escalation in targeting U.S. space assets; and the considerations that impact U.S.-China space cooperation. She also explains how freedom in space is critical to avoiding foreign dependence and why the United States must build a resilient military space architecture and not surrender global leadership in pursuing aspirational and inspirational space goals.