In early spring, historic health reform passes, extending insurance to millions of uninsured. Despite problems with workplace-based coverage, controversy over government subsidies for insurance premiums, and disparities across a large and diverse nation, dramatic shift to a single-payer system was seen as impractical.

Instead, reforms focus on expanding current social insurance programs as well as new initiatives to cover the uninsured, improve quality, and control spending. They provide a basic floor, subsidized for the poorest, but preserve consumer freedom to choose in health care. No government body dictates choice of doctor or hospital; investor-owned and private not-for-profits compete alongside government-run providers like community health centers and rural hospitals.

Left to be addressed in later phases are the difficult questions of how to slow the relentless pace of health care spending increases -- driven in part by technological change and population aging, but also perverse incentives embedded in fee-for-service payment and fragmented delivery. Pushed through despite multiple crises confronting the leadership, the final landmark health reform works in conjunction with measures enacted as part of the fiscal stimulus package to strengthen the healthcare system. Some provisions take effect immediately; others will take many years to unfold.

President Obama’s triumph on his top domestic priority? Actually, there were no votes along partisan lines, no controversy over abortion. I am describing health reform in China, which was announced almost exactly a year ago.

We do not hear much about the parallels in the US and Chinese social policy. But we cannot fully understand each other if we ignore these commonalities. We do not hear much about those who, in both societies, have been rendered destitute merely because they or a family member became sick or injured in a system with a social safety net full of gaping holes.

It will surprise many Americans to know that government financing as a share of total health spending was lower in socialist China over the last decade than in the United States. Now China has pledged about US$124 billion over 3 years to expand basic health insurance, strengthen public health and primary care, and reform public hospitals.

In China, the injustice of differential access to life-saving healthcare had sparked cases of social unrest. The April 2009 reform announcement was the culmination of years of post-SARS (2003) soul searching for a healthcare system befitting China’s dynamically transforming society. Special interests block change. (Sound familiar?) The CPC Central Committee and the State Council acknowledge that successful health reform will be “an arduous and long-term task”.  

If the US can pass sweeping health reform despite an unprecedented financial crisis, and China can envision universal health coverage for 1.3 billion while “getting old before getting rich,” then together we should be able to look past our many differences to focus on our common interests. Our two proud nations must work together to confront numerous challenges, such as upholding regional stability (e.g. on the Korean peninsula); redressing global economic imbalances (increasing health insurance can help spur China towards more domestic consumption); and investing in “green tech” for a warming planet and “grey tech” for an aging society.

* * *

When searching for insights about how other countries deal with similar challenges, Americans often look to Europe and Canada. Rarer is the comparison to counterparts across the Pacific. Yet President Obama has clearly articulated the vision of the US as a Pacific Nation, and there are developments around the Pacific Rim that merit consideration in our debates.  

Australia pioneered cost-effectiveness in health care purchasing, while the US continues to debate whether cost should be part of comparative effectiveness research and policy decisions.

Both Japan and South Korea, like Germany, have enacted long term care insurance to smooth the transition to an aging society. Their experiences might be fruitful as we implement the first national government-run long-term care insurance program, a little-heralded component of the newly passed legislation (and a fitting legacy of Senator Edward Kennedy).

Japan and Singapore provide universal coverage to older populations than ours with health systems that, although surprisingly different from each other in terms of public financing and role of market forces, both ranked among the best in the world -- and far higher than the US -- in the World Health Organization’s ranking of health systems in the year 2000. Although one may quibble with the ranking, it is indisputable that Japan spends a much smaller share of GDP on healthcare than the US does, despite being one of the oldest and longest-lived societies in the history of the world and having (like the US) a fee-for-service payment system.

Japan and South Korea are also democracies, where health policies occasionally engender heated debates. In South Korea, physicians went on nationwide strike three times to oppose the separation of prescribing from dispensing. Although Japan’s incremental reforms rarely spur such drama, the passions aroused by end-of-life care – embodied in the bizarre “death panels” controversy in the US health reform debate of 2009 – has its counterpart in the bitter nickname for Japan’s separate insurance plan for the oldest old: “hurry-up-and-die” insurance.

Yet Japan, Singapore, and Hong Kong all offer health systems that provide reasonable risk protection and quality of care for populations older than ours, with a diverse range of government and market roles in financing and delivery, while spending far less per capita than the US.

No system has all the answers. But the US and our neighbors across the vast Pacific have a common interest in sharing what we’ve found that works for health reform. Despite divergence in our political and economic systems, we all value long, healthy lives for ourselves and our children -- and we’re united in health reforms that try to further that goal.

This annual award, which carries a cash prize of $10,000, honors a journalist not only for a distinguished body of work, but also for the particular way that work has helped American readers to understand the complexities of Asia. It is awarded jointly by the Walter H. Shorenstein Asia-Pacific Center at Stanford University, and the Shorenstein Center on Press, Politics, and Public Policy at Harvard University, part of the Kennedy School of Government. Events have been hosted alternately at both centers.

Barbara Crossette serves as United Nations correspondent for The Nation and is a freelance writer on foreign policy and international affairs. Her articles and essays have appeared periodically in World Policy Journal, published at the New School University in New York. "Will John Bolton Ruin the UN?" an article published in Foreign Policy, in the July/August 2006, presaged the campaign that led to the resignation of the ambassador.

Crossette was the New York Times bureau chief at the United Nations from 1994 to 2001. She was earlier a Times chief correspondent in Southeast Asia and South Asia and a diplomatic reporter in Washington. She has also reported from Central America, the Caribbean, and Canada, and been deputy foreign editor and senior editor in charge of the Times' weekend news operations. Before joining newspaper paper in 1973, Crossette worked for The Evening and Sunday Bulletin in Philadelphia and The Birmingham Post in Birmingham, England.

She is the author of several books on Asia, including So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas (1995) and The Great Hill Stations of Asia (1998). The latter was a New York Times notable book of the year in 1998. In 2000, Crossette wrote a survey of India and Indian-American relations, India: Old Civilization in a New World, for the Foreign Policy Association in New York. She is also the author of India Facing the 21st Century (1993). Most recently she was a co-author with George Perkovich of a section on India in the 2009 book Powers and Principles: International Leadership in a Shrinking World.

In 1999, Crossette received the Business Council of the United Nations' Korn Ferry Award for outstanding reporting on the organization, and in 2003 the United Nations Correspondents' Association's lifetime achievement award. In 2008, she was awarded a Fulbright prize for her contributions to international understanding.

Crossette has taught journalism, politics, and international affairs at a broad range of institutions, including the Columbia University Graduate School of Journalism, Punjab University, Princeton University, Bard College, and the Royal University of Phnom Penh. In 2004 and 2005 she also worked with journalists in Brazil as a Knight International Press Fellow.

Born in Philadelphia, Crossette received a BA in history and political science from Muhlenberg College. She is a member of the Council on Foreign Relations and the Women's Foreign Policy Group.

In 2009-2010, the Program on Human Rights will partner with FCE and DLCL to launch part 2 of the Contemporary History and the Future of Memory series by adding "Reconciliation" to the mission.  This series will examine scholarly and institutional efforts to create new national narratives that walk the fine line between before and after, memory and truth, compensation and reconciliation, justice and peace. Some work examines communities ravaged by colonialism and the great harm that colonial and post-colonial economic and social disparities cause.   The extent of external intervention creates discontinuities and dislocation, making it harder for people to claim an historical narrative that feels fully authentic.  Another response is to set up truth-seeking institutions such as truth commissions. Historical examples of truth commissions in South Africa, Peru, Chile, Argentina, Morocco inform more current initiatives in Canada, Cambodia, Colombia, Kenya, and the United States.  While this range of economic, social, political and legal modalities all seek to explain difficult pasts to present communities, it is not yet clear which approach yields greater truth, friendship, reconciliation and community healing.  The "History, Memory, and Reconciliation" series will explore these issues.

The series will have its first event in February 2010. Multiple international scholars are invited.  

The Social Agenda for Democracy in Latin America is a policy-oriented research initiative of the Global Center for Development and Democracy, which was founded by former Peruvian President Alejandro Toledo in 2006. Authored by a taskforce of 20 former Latin American Presidents, as well as development experts from academia, the private sector, and multi-lateral organizations, the Social Agenda comprises 16 pressing social issues and 63 specific public and private policy recommendations to the region's current heads of state.

From the Washington, D.C. launch of the Social Agenda for Democracy in Latin America:

The Global Center for Development and Democracy, founded and presided over by former Peruvian President Alejandro Toledo, along with The Johns Hopkins University Paul H. Nitze School of Advanced International Studies (SAIS), the National Endowment for Democracy, the Brookings Institution, and the Inter-American Dialogue, is pleased to invite you to join us at the Falk Auditorium at the Brookings Institution on Tuesday, November 3, from 2:30 to 4:30 p.m. for a presentation of The Social Agenda for Democracy in Latin America for the Next Twenty Years by Dr. Alejandro Toledo and the following former presidents: Vicente Fox of Mexico; Carlos Mesa, Bolivia; Nicolas Ardito Barletta, Panama; Ricardo Maduro, Honduras; and Vinicio Cerezo, Guatemala.

The Global Center for Development and Democracy has sponsored five Presidential Meetings over the last two years, at which a Presidential Task Force (including 20 former presidents of Latin American countries) has met with leading experts from policy-oriented academia, multilateral organizations, the private sector, and members of civil society to consider the innovative policy research of those experts and to discuss what the former heads of state consider to be the 15 most important social issues facing the region.  The conclusions of their research and discussions at these meetings have been synthesized into a report that will be shared with the sitting presidents of Latin American nations at the Ibero-American Summit in Estoril, Portugal, on December 1, 2009 – as well as with President Obama, the Prime Minister of Canada, and the heads of state of the European Union.  The report will present specific recommendations for actions to significantly reduce poverty, inequality, and social exclusion, as well as to strengthen democratic institutions in Latin America. The report will also include mechanisms for carrying out a twenty-year program of monitoring the results of the policy initiative.

Full text of the Social Agenda for Democracy in Latin America (pdf).