Amidst evolving geopolitical shifts, the foundation of U.S. nuclear deterrence, forged in the crucible of the Cold War, faces a new set of challenges. The principle of mutually assured destruction (MAD), once the bedrock of deterrence, is now being tested by Russia's aggressive posturing and China's strategic advancements. In the wake of Russia's invasion of Ukraine and signals of a willingness to employ tactical nuclear weapons, questions arise about the efficacy of traditional deterrence strategies. Concurrently, China's expanding nuclear arsenal adds complexity to the equation. Do these developments mean America needs to rethink its deterrence strategy? 

In a new paper, “China’s Nuclear Enterprise: Trends, Developments, and Implications for the United States and Its Allies,” FSI Center Fellow Oriana Skylar Mastro focuses on the Chinese perspective of the equation and examines recent trends in Chinese military doctrine and their implications for U.S. deterrence strategy. Mastro’s contribution is part of a new report, Project Atom 2023: A Competitive Strategies Approach for U.S. Nuclear Posture through 2035, produced by the CSIS Project on Nuclear Issues.

A fundamental premise underlying Mastro’s analysis is that China merits distinct scrutiny differently from Russia, and that the two countries should not be considered  “nuclear peers.” Although China is indeed engaging in nuclear force modernization, Mastro contends that the nation is still adhering to its fundamental nuclear policy: minimal retaliation capability and a no-use-first pledge.

While some have been troubled by China’s turn to regional nuclear options like the DF-26, an intermediate-range ballistic missile capable of carrying both conventional and nuclear warheads, Mastro asserts that this is because “they are regional weapons lower on the escalation ladder.” Rather than trying to achieve parity with the United States, she contends that Beijing’s objective is to preserve a credible second-strike capability, which is essential to the concept of deterrence.

Instead of prescribing specific alterations to U.S. force posture or nuclear modernization, Mastro suggests that any changes in U.S. defense strategies carefully consider the impact on Chinese nuclear strategy. The key is to preserve China’s minimal retaliation capability and its pledge to refrain from initiating nuclear warfare: “the most important goal for U.S. deterrence policy should be to ensure it does not encourage a change in China’s nuclear policy and in posture.”

Other steps the United States should take, according to Castro, include preventing the “co-mingling” of nuclear and conventional weapons on vessels apart from ballistic missile submarines. This precaution aims to eliminate ambiguity and mitigate the risk of possible conflict escalation. She also believes that there may be “more costs than benefits” in the proliferation of nuclear weapons among Asian allies — South Korea, Japan, and Australia. These threaten the non-proliferation regime and increase the possibility of accidents. The answer, Mastro holds, is not deployment of U.S. nuclear weapons on foreign soil, but rather increased consultations and joint planning with allies. Such collaborative efforts could reassure allies and partners of U.S. intentions even as they have minimal impact on Chinese contingency planning. 
 

In 2018, the South Korean Supreme Court passed a series of rulings requiring Mitsubishi Heavy Industries and Nippon Steel of Japan to compensate 14 Korean citizens for their unpaid labor. As of yet, neither company has agreed to comply with the ruling. The South Korean government has since announced plans to compensate survivors who were forced to work in Japanese mines and factories during the wartime period, but this remains a unilateral decision on the part of the Yoon administration, not a bilateral position between South Korea and Japan.

These tensions have ripple effects far outside of East Asia. Writing for Toyo Keizai, Daniel Sneider, an FSI Lecturer in International Policy with a focus on Asia, explains the broader geopolitical implications of these issues:

“The Americans have been urging the two countries to settle these problems in order to ease the way to the kind of security cooperation that has become visible in recent months. Joint military exercises for missile defense and other small steps to intensify trilateral coordination are taking place and a resolution of the history of problems may be key to moving ahead.”

Steps Forward

The last year has seen increased efforts to restore more functionality to the South Korea-Japan relationship. President Yoon and Prime Minister Kishida met briefly on the sidelines of the September 2022 UN General Assembly meeting in New York, which was followed by respective visits of Yoon to Tokyo in March 2023 and Kishida to Seoul two months later in May, the first such visits in over 11 years.

The Camp David summit, which brought the U.S., South Korea, and Japan together as strategic partners, is the latest step on the hoped-for road to institutionalized security cooperation between the three nations.

Speaking to NBC, Shorenstein Fellow Thomas Fingar explained the significance of the weekend.

“The importance of this [summit] is that it was a genuine trilateral meeting, which means the Japanese and the Koreans are talking to one another as opposed to the U.S. dealing separately with each of them.”

In contrast to the idyllic Camp David setting, the three leaders are faced with a weighty set of issues, noted Sneider, including the crisis triggered by the Ukraine war, North Korea’s aggressive posture, as well as growing concerns about China.

Oriana Skylar Mastro, an FSI Center Fellow and an expert on security, conflict resolution, and the Chinese military elaborated further on the mutual pressures South Korea, Japan, and the United States face:

“Since President Biden came into office, he’s really stressed strengthening alliances and partnerships as a way of protecting U.S. interests abroad. I'm sure there has been much work behind the scenes to try to get these two countries to come together. In terms of the timing [of this summit], it's of course partially because of the accumulation of these concerns over China. I think also the war in Ukraine has done a lot to really open up leaders' eyes to the dangers of having neighbors with territorial hopes and claims that also have strong militaries that could potentially be undeterred from using force. I think it's fair to say that this has also pushed these two countries to rethink their own strategies for security.”

An Uncertain Future

The official summit documents outline both a vision of partnership and offer a variety of practical agreements on everything from annual leadership summits to meetings on economic and cyber security, and a proposal for how to move forward with joint military exercises. Notably, the two-paragraph ‘commitment to consult’ on responses to ‘regional challenges, provocations, and threats affecting our collective interests and security’ — while not a fully embodied collective security agreement — is nonetheless a “stunning achievement,” says Daniel Sneider.

Despite agreeing on a hefty laundry list of shared concerns and security goals, the way forward for additional trilateralization between the United States, Japan, and South Korea is not necessarily clear. Oriana Mastro explained: 

“Even though they might have shared threat perceptions, there is still a lot of trust that has to happen between nations for them to take coordinated military approaches. If two countries, for example, exercise together — and that's one of the things that the Biden administration is hoping to get out of this summit: more routine trilateral exercises — you get to learn a lot about another country's military, and that only really happens between friends. That’s also true of intel sharing. When you share intelligence, you’re not only sharing information, you're sharing how you get intelligence, which can also be sensitive. So while they've shared these threats for a while, it hasn't really gotten to the level in which they were willing to take risks in terms of the relationship between South Korea and Japan to become closer in the security space in a way that would help them combat these issues together.”

Besides the challenges of international diplomacy, Yoon, Kishida, and Biden also face domestic hurdles that could hinder further cooperation.

In a comment to the Wall Street Journal, Gi-Wook Shin noted that, “Yoon only entered politics a few years ago. If his party loses the election, I don’t know who will stay with him.” Improving South Korea-Japan relations was a major platform of the Yoon campaign, and backlash against his administration could yield disinterest or even renewed hostility toward continuing his efforts. 

Daniel Sneider sees similar challenges for Biden and Kishida. Writing in East Asia Forum, he cautioned:

“President Joe Biden is already embroiled in an election campaign that threatens to bring Donald Trump and his isolationist views back to power. The Camp David summit was barely noticed amid the constant flow of domestic political news, though it mostly received welcome praise in the media. . . Imprisoned by domestic politics, the White House will likely be unable to give substance to this emergent partnership.”

In the case of Kishida, the decision to release wastewater from the Fukushima nuclear site, which came just days after the conclusion of the summit, has been particularly counterproductive. Sneider continued:

“Prime Minister Fumio Kishida has been waiting for a bump from the Camp David summit. But he is experiencing a deepening slide in opinion polls. The Fukushima release faces opposition within Japan, including from fishermen and others worried about boycotts of Japanese products in China and South Korea. Talk of an early parliamentary election in Japan, intended to consolidate Kishida’s claim to long-term leadership, is now on hold.”

Where is the trilateral U.S.-Japan-South Korea relationship headed next? Follow FSI scholars to stay informed about the latest developments. Register to receive alerts to your inbox either weekly or monthly.   

This story was updated on September 18, 2023, to reflect the passing of Victor Fuchs.

It is hardly news that America’s health care system is complicated, expensive, and, in many ways, dysfunctional and that the nation’s health care outcomes are falling behind those of other, even sometimes poorer, countries. The problems of rising costs and disparities in access and outcomes were already well established in 1974, when Victor Fuchs, the late Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy at Stanford, first published his seminal book Who Shall Live? Health, Economics and Social Choice. In what turned out to be the first edition of the book, Fuchs applied fundamental concepts from economic theory to health and medical care in an innovative manner that hadn't been attempted previously, presenting an economic framework for addressing health and medical care challenges and emphasizing the importance of choice at both individual and societal levels. The publication became a classic introduction to health economics and is recognized for pioneering the field.

Now a third edition of Who Shall Live? has been released by World Scientific Publishing, co-authored by Karen Eggleston, director of Shorenstein APARC’s Asia Health Policy Program. This edition adds supplemental research and an all-new section that focuses on the decade 2012–21, specifically looking at the Affordable Care Act, the COVID-19 pandemic, the intersection of health and politics, and the state of expenditures and outcomes during that period.

Eggleston was honored to be able to work with Fuchs, who had also been a senior fellow emeritus at the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research, but noted that “it was a little depressing to hear him conclude that the pandemic would not be the 'wake-up call’ for systemic reforms that he has spent a lifetime showing the United States needs.” Fuchs passed away peacefully in his longtime home on Stanford’s campus on September 16, 2023. He was 99.

Part of the story of U.S. health care is its poor showing compared to other, often less-affluent nations. Japan is one of the comparison countries in the updated section on the last decade; in one example, Eggleston describes, “between 2012 and 2019 (pre-pandemic), life expectancy at birth did not increase at all in the United States, while it increased 0.18 years per annum in Japan, and 0.16 years per annum across 10 other high-spending OECD countries.” This is despite the fact that “in 2019, Japan spent only 63% of what the United States spends on healthcare (as a share of GDP)… Why can’t we do better for Americans?” 

This question is precisely the one that Who Shall Live? aims to answer—that the state of any health care system is a result of “the necessity of choice at both the individual and social levels.” To shrink the costs of health care in the United States and improve outcomes, different choices have to be made—by patients (in their personal lifestyles and behavior), by physicians, by hospitals, and by the U.S. government.

In July 2023, Professor Rozelle joined a group of ten academics from the US, including both professors and think tank professionals, and traveled to China where they met with 12 scholars from China. The group spent three days at Peking University in discussion and went on several site visits around Beijing (to the Foreign Ministry; Xinhua New Agency; American Chamber of Commerce in Beijing; the US Embassy) where they furthered dialogue on the current state of scholarly exchange and how to improve it.

There were several key takeaways from the meetings:

Scholarly exchange is still occurring but at a much lower level compared with 5 to 10 years ago. 
Scholarly exchange is suffering collateral damage from the deteriorating US-China relations.

Challenges to scholarly exchange exist within both countries.
Rozelle remarked, “when we [the 10 academics from the US] got together with our academic colleagues from China, we immediately bonded and opened up with a sense of camaraderie, we almost immediately knew we were facing the same challenges on both sides of the Pacific.”

Through discussion, Rozelle documented 15 different issues that are inhibiting research efforts within China, (such as increased privacy laws, shutting off access to public databases, putting strict limits on access to archives, and more,) and 10 things in the US hindering research (such as, not issuing visas to engineering/biomedicine/science Ph.D students and post-docs from China). 

The biggest issue both sides face is the perception that scholarly exchange may compromise national security.
A small fraction of scholarly exchange is related to national security issues, the other share of scholarly exchange is much more related to positive outcomes in research, technology, and national growth. A secular decline of scholarly exchange is going to have large negative impacts on growth, equity and happiness in both countries as well as around the world.

Leaders in both countries need to define what types of scholarly exchange concern national security.
What can be done to improve scholarly exchange? Both countries have stated that scholarly exchange is related to national security, which is what has led to the decline (and prohibition, in some cases,) of scholarly exchange.

The challenge is that there has been no definition or clarification given of what types of scholarly exchange are sensitive to this matter. As a result, lower-level bureaucrats both in the United States and in China have taken risk-averse approaches in implementing these efforts by making it difficult to do almost all research. The two groups of scholars almost unanimously agreed that what is urgently needed is for upper-level leaders in the two countries to officially define what specific topic areas are national security concerns, and which are not.

In early October 2023 the delegation from China will join the US delegation in Washington DC to continue the conversation and strategize on how to foster more scholarly exchange between the two nations.

Rozelle is currently working on producing a brief that will seek to demonstrate both the benefits of US-China scholarly exchange as well as the cost of the disruption. Once published, the brief will be part of the overall effort as well as being linked here.