Stanford University

Elections

Health reform spans the Pacific

Authors
Karen Eggleston
News Type
News
Date
Paragraphs

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.

All News button
1

The Nature of Technology

-

This is part of the Stanford seminar series on Science, Technology, and Society.

Abstract
How do transformative new technologies arise, and how does innovation really work? Conventional thinking ascribes the invention of technologies to “thinking outside the box,” or vaguely to genius or creativity, but Arthur shows that such explanations are inadequate. Rather, technologies are put together from pieces  themselves technologies  that already exist. Technologies therefore share common ancestries, and combine, morph, and combine again, to create further technologies. Technology evolves much as a coral reef builds itself from activities of small organisms  it creates itself from itself; and all technologies are descended from earlier technologies.

W. Brian Arthur is an External Faculty Member at the Santa Fe Institute, IBM Faculty Fellow, and Visiting Researcher in the Intelligent Systems Lab at PARC (formerly Xerox Parc). From 1983 to 1996 he was Morrison Professor of Economics and Population Studies at Stanford University. He holds a Ph.D. from Berkeley in Operations Research, and has other degrees in economics, engineering and mathematics.

Arthur pioneered the modern study of positive feedbacks or increasing returns in the economy--in particular their role in magnifying small, random events in the economy. This work has gone on to become the basis of our understanding of the high-tech economy. He has recently published a new book: The Nature of Technology: What it Is and How it Evolves, "an elegant and powerful theory of technology's origins and evolution."He is also one of the pioneers of the science of complexity.

Arthur was the first director of the Economics Program at the Santa Fe Institute in New Mexico, and has served on SFI's Science Board and Board of Trustees. He is the recipient of the Schumpeter Prize in economics, the Lagrange Prize in complexity science, and two honorary doctorates.

Arthur is a frequent keynote speaker on such topics as: How exactly does innovation work and how can it be fostered? What is happening in the economy, and how should we rethink economics? How is the digital revolution playing out in the economy? How will US and European national competitiveness fare, given the rise of China and India?

Lynn Eden is Associate Director for Research at the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford. In the area of international security, Eden has focused on U.S. foreign and military policy, arms control, the social construction of science and technology, and organizational issues regarding nuclear policy and homeland security. She co-edited, with Steven E. Miller, Nuclear Arguments: Understanding the Strategic Nuclear Arms and Arms Control Debates (Ithaca, N.Y.: Cornell University Press, 1989). She was an editor of The Oxford Companion to American Military History (New York: Oxford University Press, 2000), which takes a social and cultural perspective on war and peace in U.S. history. That volume was chosen as a Main Selection of the History Book Club.

Eden's book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation(Ithaca: Cornell University Press, 2004; New Delhi: Manas Publications, 2004) explores how and why the U.S. government--from World War II to the present--has greatly underestimated the damage caused by nuclear weapons by failing to predict damage from firestorms. It shows how well-funded and highly professional organizations, by focusing on what they do well and systematically excluding what they don't, may build a poor representation of the world--a self-reinforcing fallacy that can have serious consequences, from the sinking of the Titanic to not predicting the vulnerability of the World Trade Center to burning jet fuel. Whole World on Fire won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Co-sponsored by STS, CISAC, and WTO.

Arthur's new book, The Nature of Technology, will be available for purchase.

Please bring lunch; drinks and light refreshments will be provided.

Reuben W. Hills Conference Room

Brian Arthur External Professor Speaker Santa Fe Institute

Lynn Eden

Not in residence

0
Affiliate
rsd15_078_0365a.jpg PhD

Lynn Eden is a Senior Research Scholar Emeritus. She was a Senior Research Scholar at Stanford University's Center for International Security and Cooperation until January 2016, as well as was Associate Director for Research. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford.

In the area of international security, Eden has focused on U.S. foreign and military policy, arms control, the social construction of science and technology, and organizational issues regarding nuclear policy and homeland security. She co-edited, with Steven E. Miller, Nuclear Arguments: Understanding the Strategic Nuclear Arms and Arms Control Debates (Ithaca, N.Y.: Cornell University Press, 1989). She was an editor of The Oxford Companion to American Military History (New York: Oxford University Press, 2000), which takes a social and cultural perspective on war and peace in U.S. history. That volume was chosen as a Main Selection of the History Book Club.

Eden's book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation (Ithaca: Cornell University Press, 2004; New Delhi: Manas Publications, 2004) explores how and why the U.S. government--from World War II to the present--has greatly underestimated the damage caused by nuclear weapons by failing to predict damage from firestorms. It shows how well-funded and highly professional organizations, by focusing on what they do well and systematically excluding what they don't, may build a poor representation of the world--a self-reinforcing fallacy that can have serious consequences, from the sinking of the Titanic to not predicting the vulnerability of the World Trade Center to burning jet fuel. Whole World on Fire won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Eden has also written on life in small-town America. Her first book, Crisis in Watertown (Ann Arbor: University of Michigan Press, 1972), was her college senior thesis; it was a finalist for a National Book Award in 1973. Her second book, Witness in Philadelphia, with Florence Mars (Baton Rouge: Louisiana State University Press, 1977), about the murders of civil rights workers Schwerner, Chaney, and Goodman in the summer of 1964, was a Book of the Month Club Alternate Selection.

CV
Lynn Eden Senior Research Scholar and Associate Director of Research Speaker CISAC
Seminars

Scholars-At-Risk at Stanford

-

Join Scholars at Risk at Stanford University on Wednesday, April 28 at 12:00 PM for a behind the scenes look at struggles for freedom of speech around the world and the courageous individuals who challenge attempts to control what people think. The goal of this event is to increase awareness and interest in institutionalizing a Scholars at Risk program at Stanford and to encourage faculty and administration to begin thinking about hosting at-risk scholars.This event is cosponsored by the Scholars at Risk Network, the Center for Russian, East European and Eurasian Studies (CREEES), and the Hamid and Christina Moghadam Program in Iranian Studies.

Robert Quinn is the founding Executive Director of the Scholars at Risk Network, a collaboration of more than 220 universities and colleges in 29 countries dedicated to protecting threatened intellectuals and promoting respect for freedom of inquiry, expression and university values. 

The Scholars at Risk Network seeks to bridge the gap between the human rights and higher education communities, building local, regional and global capacity to defend the intellectual space. The Network provides direct assistance to gravely threatened intellectuals, and conducts education and advocacy to target root causes of intellectual repression and to promote systemic change.

Mr. Quinn currently serves on the Steering Committee of the Network for Education and Academic Rights (NEAR), based in London, UK; the governing Council of the Magna Charta Observatory, based in Bologna, Italy; and is a fellow with the Woodrow Wilson Visiting Fellows Program in Washington, DC.  He previously served as a member of the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science; a member of the Human Rights Committee of the Association of the Bar of the City of New York; and an adjunct professor of law at Fordham Law School.  He received his A.B. cum laude from Princeton in 1988, and his J.D. cum laude from Fordham in 1994. 

Fatemeh Haghighatjoo is an expert on Iran's internal affairs and a prominent advocate of political reform, human rights and women's rights. She was a member of the Iranian Parliament from 2000-2004 and chaired the Student Movement Caucus. She was a deputy of the Mosharekat Caucus in the 6th Parliament as well as a member of the political bureau of the Mosharekat party in Iran.  Dr. Haghighatjoo was one of the most courageous in standing up publicly to the hard-line Iranian leadership. She resigned in 2004 after a crackdown on reformers, and left Iran in 2005. More recently, Dr. Haghighatjoo has held several academic posts in the United States: Assistant Professor In-Residence at the University of Connecticut, Fellow in the Women and Public Policy Program at Harvard University's Kennedy School of Government, and Visiting Scholar at the Center for International Studies at the Massachusetts Institute of Technology. Dr. Haghighatjoo earned her Ph.D. in Counseling from Tarbiat Moalem University, served as a Professor at the National University of Iran, and authored Search for Truth (2002). She has served as Vice President of the Psychology and Counseling Organization in Iran and has been honored as a Young Global Leader by the World Economic Forum. Dr. Haghighatjoo has been extensively interviewed and quoted in the U.S. and international media on Iran's domestic politics.

Mohsen Sazegara is an Iranian dissident, writer and political activist. His PhD thesis at the University of London, Royal Holloway focused on religious intellectuals in Iran. He has been a visiting professor at several universities in Iran, and has held visiting scholar positions at Yale University and Harvard University. A founding member of the Iranian Revolutionary Guard Corps, he served as political deputy in the prime minister's office and held several other political offices. He became disillusioned with the revolutionary government and left it in 1989. He later served as publisher of several reformist newspapers closed by regime hardliners and was also managing director of Iran's press cooperative company. Dr. Sazegara was recently appointed as the second Visiting Fellow in Human Freedom at the George W. Bush Institute at the Southern Methodist University in Dallas, Texas. He is the president of Research Institute on Contemporary Iran (RICI).

Natalia Koulinka joins CREEES as a Visiting Scholar from January - December 2010. She is the recipient of a Scholar Rescue Fund fellowship grant from the Institute of International Education, and supported by more than a dozen Centers, Departments, and Programs in the School of Humanities and Sciences and the Freeman Spogli Institute for International Studies at Stanford.

Koulinka was born and raised in Oshmiany in the Republic of Belarus. She graduated from the Belarusian State University in Minsk with both undergraduate and graduate degrees. From 1992-1996, she helped create and run the "Women's Newspaper," the only independent women's paper in Belarus which soon became popular in Russia too. As the paper's editor-in-chief, she focused on women in business and politics. Since 2006, she has been the news editor for the radio station Unistar in Minsk. In addition to her work as a journalist, Koulinka was an associate professor at Belarusian State University 2001-08. She is also the co-editor of the book, Krasnim po Belomy ("Red on White"), which is a collection of texts by murdered Belarus journalist, Veronika Cherkasova. In 2008-09, Koulinka was the Lyle and Corinne Nelson International Fellow, John S. Knight Fellowship for Professional Journalists at Stanford University. During her fellowship year at CREEES she will work on the research project topic "A Social History of the Soviet School of Journalism."

Oksenberg Conference Room

Fatemeh Haghighatjoo Speaker
Mohsen Sazegara Speaker
Natalia Koulinka Speaker
Robert Quinn Moderator

Larry Diamond

CDDRL
Stanford University
Encina Hall, C147
616 Jane Stanford Way
Stanford, CA 94305-6055

(650) 724-6448 (650) 723-1928
0
Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies
William L. Clayton Senior Fellow at the Hoover Institution
Professor, by courtesy, of Political Science and Sociology
diamond_encina_hall.png MA, PhD

Larry Diamond is the William L. Clayton Senior Fellow at the Hoover Institution, the Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies (FSI), and a Bass University Fellow in Undergraduate Education at Stanford University. He is also professor by courtesy of Political Science and Sociology at Stanford, where he lectures and teaches courses on democracy (including an online course on EdX). At the Hoover Institution, he co-leads the Project on Taiwan in the Indo-Pacific Region and participates in the Project on the U.S., China, and the World. At FSI, he is among the core faculty of the Center on Democracy, Development and the Rule of Law, which he directed for six and a half years. He leads FSI’s Israel Studies Program and is a member of the Program on Arab Reform and Development. He also co-leads the Global Digital Policy Incubator, based at FSI’s Cyber Policy Center. He served for 32 years as founding co-editor of the Journal of Democracy.

Diamond’s research focuses on global trends affecting freedom and democracy and on U.S. and international policies to defend and advance democracy. His book, Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency, analyzes the challenges confronting liberal democracy in the United States and around the world at this potential “hinge in history,” and offers an agenda for strengthening and defending democracy at home and abroad.  A paperback edition with a new preface was released by Penguin in April 2020. His other books include: In Search of Democracy (2016), The Spirit of Democracy (2008), Developing Democracy: Toward Consolidation (1999), Promoting Democracy in the 1990s (1995), and Class, Ethnicity, and Democracy in Nigeria (1989). He has edited or coedited more than fifty books, including China’s Influence and American Interests (2019, with Orville Schell), Silicon Triangle: The United States, China, Taiwan the Global Semiconductor Security (2023, with James O. Ellis Jr. and Orville Schell), and The Troubling State of India’s Democracy (2024, with Sumit Ganguly and Dinsha Mistree).

During 2002–03, Diamond served as a consultant to the US Agency for International Development (USAID) and was a contributing author of its report, Foreign Aid in the National Interest. He has advised and lectured to universities and think tanks around the world, and to the World Bank, the United Nations, the State Department, and other organizations dealing with governance and development. During the first three months of 2004, Diamond served as a senior adviser on governance to the Coalition Provisional Authority in Baghdad. His 2005 book, Squandered Victory: The American Occupation and the Bungled Effort to Bring Democracy to Iraq, was one of the first books to critically analyze America's postwar engagement in Iraq.

Among Diamond’s other edited books are Democracy in Decline?; Democratization and Authoritarianism in the Arab World; Will China Democratize?; and Liberation Technology: Social Media and the Struggle for Democracy, all edited with Marc F. Plattner; and Politics and Culture in Contemporary Iran, with Abbas Milani. With Juan J. Linz and Seymour Martin Lipset, he edited the series, Democracy in Developing Countries, which helped to shape a new generation of comparative study of democratic development.

Download full-resolution headshot; photo credit: Rod Searcey.

Former Director of the Center on Democracy, Development and the Rule of Law
Faculty Chair, Jan Koum Israel Studies Program
Hide publication sections
Off
Date Label
Larry Diamond Director Moderator CDDRL
Conferences

Seminar on the Regional Dimensions of Authoritarianism in the Arab World

News Type
News
Date
Paragraphs

On March 30, 2010, Prof. Samer Shehata from Georgetown University gave a research seminar for the Program on Arab Reform and Democracy at CDDRL titled The Regional Dimensions of Authoritarianism in the Arab World.  Prof. Shehata’s talk was in response to the research puzzle, as he called it, of the persistence of authoritarian politics at the regional level in the Arab world. He argued that the subject that has received most attention in political science is the question of authoritarianism and absence of democracy. The question of why there are no democracies has offered a number of possible reasons including: the qualities and consequences of oil and rentier politics; absent or weak civil societies in the Arab world; social class-based explanations; the issue of political liberalization instead of democratization; external factors such as US support for authoritarian regimes, which he argued has not decreased since the end of the Cold War; regional conflicts like Palestine/Israel and the Gulf wars; institutions of authoritarianism including how elections, parliaments and single parties work; Islamist politics creating deep divisions among opposition groups; and patronage, clientelism and the (absence of) social contract.

Prof. Shehata then proceeded to say that there has been some positive development in the approach to democracy in the Arab world, but that there remains insufficient attention to the regional dimensions of authoritarianism. He argued that the Arab world is authoritarian not just on the state level, but also on the regional level. As International Relations specialists have spoken about the existence of an Arab regional system, the institutional dimension of this system, such as the Arab League, needs to be studied.

He stated that there are three mechanisms of the reproduction of authoritarianism on the regional level: authoritarian learning, authoritarian cooperation, and regional organizations. Cases of authoritarian learning take both direct and indirect forms where certain regimes “learn” from one another. He gave the example of constitutional amendments that allow elections but that give the illusion of competition, where electoral outcomes are similar. In Tunisia, for example, Ben Ali “learned” from the Algerian experience by not allowing Islamists an electoral opening.

Authoritarian cooperation, he went to argue, occurs mainly regarding security matters. He gave the example of certain activists not being to allowed certain countries in the Arab world (like the Tunisian Moncif Marzouki, who was not allowed into Lebanon). Such “cooperation” widens the scope of authoritarianism beyond the borders of individual states.

Prof. Shehata’s ended with a discussion of the third mechanism, regional organizations. He talked about institutionalized cooperation within the Arab League and the GCC, calling the Arab League a “club for authoritarian regimes” that is not committed to democracy. An example of this in action is the Arab League accords on security and anti-terrorism which have ended up extending authoritarian rules across the Arab world. Another example is the Arab media charter that was put in place in February 2008, and which limits internet and media freedom. Prof. Shehata acknowledged that further research needs to be done on those three mechanisms and the floor was then opened to questions from the audience.

Hero Image
shehata
All News button
1

Getting to Zero: Why U.S. Nuclear Doctrine Will Make it Extremely Difficult

-

Lynn Eden is acting co-director (2008-09) at the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford. In the area of international security, Eden has focused on U.S. foreign and military policy, arms control, the social construction of science and technology, and organizational issues regarding nuclear policy and homeland security. She co-edited, with Steven E. Miller, Nuclear Arguments: Understanding the Strategic Nuclear Arms and Arms Control Debates (Ithaca, N.Y.: Cornell University Press, 1989). She was an editor of The Oxford Companion to American Military History (New York: Oxford University Press, 2000), which takes a social and cultural perspective on war and peace in U.S. history. That volume was chosen as a Main Selection of the History Book Club.

Eden's book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation(Ithaca: Cornell University Press, 2004; New Delhi: Manas Publications, 2004) explores how and why the U.S. government--from World War II to the present--has greatly underestimated the damage caused by nuclear weapons by failing to predict damage from firestorms. It shows how well-funded and highly professional organizations, by focusing on what they do well and systematically excluding what they don't, may build a poor representation of the world--a self-reinforcing fallacy that can have serious consequences, from the sinking of the Titanic to not predicting the vulnerability of the World Trade Center to burning jet fuel. Whole World on Fire won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Eden has also written on life in small-town America. Her first book, Crisis in Watertown (Ann Arbor: University of Michigan Press, 1972) was her college senior thesis; it was a finalist for a National Book Award in 1973. Her second book, Witness in Philadelphia, with Florence Mars (Baton Rouge: Louisiana State University Press, 1977), about the murders of civil rights workers Schwerner, Chaney, and Goodman in the summer of 1964, was a Book of the Month Club Alternate Selection.

Providing commentary on Dr. Eden's paper is Lieutenant Colonel John Vitacca, a national defense fellow for 2009-2010 at CISAC. 

John holds a Bachelor of Business Administration degree in Marketing from Texas A&M University, a Master of Business Administration degree in Management from Rensselaer Polytechnic Institute, and a Master of Arts degree in Military Operational Art and Science from Air Command and Staff College, Air University, Alabama.  He is a command pilot with over 3,400 flight hours in the B-2 and B-52, qualified as both an instructor and evaluator pilot.  Prior to coming to CISAC, John served in various assignments including a tour at the Pentagon as the Chief of the Global Persistent Attack Branch and the B-2/Next Generation Bomber subject matter expert.   Most recently, he was the Commander of the 393d Bomb Squadron at Whiteman Air Force Base, one of only two operational B-2 stealth bomber squadrons in the USAF.  His research at CISAC will focus on nuclear weapons policy issues.

Reuben W. Hills Conference Room

Lynn Eden

Not in residence

0
Affiliate
rsd15_078_0365a.jpg PhD

Lynn Eden is a Senior Research Scholar Emeritus. She was a Senior Research Scholar at Stanford University's Center for International Security and Cooperation until January 2016, as well as was Associate Director for Research. Eden received her Ph.D. in sociology from the University of Michigan, held several pre- and post-doctoral fellowships, and taught in the history department at Carnegie Mellon before coming to Stanford.

In the area of international security, Eden has focused on U.S. foreign and military policy, arms control, the social construction of science and technology, and organizational issues regarding nuclear policy and homeland security. She co-edited, with Steven E. Miller, Nuclear Arguments: Understanding the Strategic Nuclear Arms and Arms Control Debates (Ithaca, N.Y.: Cornell University Press, 1989). She was an editor of The Oxford Companion to American Military History (New York: Oxford University Press, 2000), which takes a social and cultural perspective on war and peace in U.S. history. That volume was chosen as a Main Selection of the History Book Club.

Eden's book Whole World on Fire: Organizations, Knowledge, and Nuclear Weapons Devastation (Ithaca: Cornell University Press, 2004; New Delhi: Manas Publications, 2004) explores how and why the U.S. government--from World War II to the present--has greatly underestimated the damage caused by nuclear weapons by failing to predict damage from firestorms. It shows how well-funded and highly professional organizations, by focusing on what they do well and systematically excluding what they don't, may build a poor representation of the world--a self-reinforcing fallacy that can have serious consequences, from the sinking of the Titanic to not predicting the vulnerability of the World Trade Center to burning jet fuel. Whole World on Fire won the American Sociological Association's 2004 Robert K. Merton Award for best book in science, knowledge, and technology.

Eden has also written on life in small-town America. Her first book, Crisis in Watertown (Ann Arbor: University of Michigan Press, 1972), was her college senior thesis; it was a finalist for a National Book Award in 1973. Her second book, Witness in Philadelphia, with Florence Mars (Baton Rouge: Louisiana State University Press, 1977), about the murders of civil rights workers Schwerner, Chaney, and Goodman in the summer of 1964, was a Book of the Month Club Alternate Selection.

CV
Lynn Eden Senior Research Scholar and Associate Director for Research, CISAC Speaker

John Vitacca

not in residence

0
Visiting Scholar
Vitacca.jpg

Representing the United States Air Force, Lieutenant Colonel John Vitacca is a national defense fellow for 2009-2010 at CISAC. 

John holds a Bachelor of Business Administration degree in Marketing from Texas A&M University, a Master of Business Administration degree in Management from Rensselaer Polytechnic Institute, and a Master of Arts degree in Military Operational Art and Science from Air Command and Staff College, Air University, Alabama.  He is a command pilot with over 3,400 flight hours in the B-2 and B-52, qualified as both an instructor and evaluator pilot.  Prior to coming to CISAC, John served in various assignments including a tour at the Pentagon as the Chief of the Global Persistent Attack Branch and the B-2/Next Generation Bomber subject matter expert.   Most recently, he was the Commander of the 393d Bomb Squadron at Whiteman Air Force Base, one of only two operational B-2 stealth bomber squadrons in the USAF.  His research at CISAC focused on nuclear weapons policy issues.

John Vitacca Visiting Scholar, CISAC Commentator
Seminars

Comparing Public and Private Hospitals in China: Evidence from Guangdong

Paragraphs

Background: The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.

Methods: We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.

Results: Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical
professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.

Conclusions: In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
BMC Health Services Research
Authors
Karen Eggleston

The Contribution of Health Plans and Provider Organizations to Variations in Measured Plan Quality

Paragraphs

OBJECTIVE: Some argue that health plans have minimal impacts on quality of care and that quality data collection should focus only on physician organizations. We investigate the relative impact of physician organizations and health plans on quality measures.

DESIGN: Statistical analysis of data on 9 Healthcare Effectiveness Data and Information Set (HEDIS) measures from 6 health plans and 159 provider organizations. We use regression analyses to examine the amount of variation in HEDIS measures accounted for by variation across provider organizations, and whether accounting for health plans explains additional variation. We also examine whether accounting for provider organizations explains away variation in HEDIS scores across health plans.

SETTING: Six health plans and 159 contracted provider groups in California.

MAIN OUTCOME MEASURES: Nine HEDIS scores.

RESULTS: For all nine measures studied, variation across provider organizations explains much of the HEDIS score variation. But, after accounting for variation across providers, variation across plans statistically significantly explains additional variation. We also find statistically significant differences across health plans in HEDIS rates that are not substantially affected when we control for the provider organization that cared for the patient.

CONCLUSIONS: On their face, these results suggest that plans can influence quality independent of the selection of physician organizations with which they contract, in contrast to hypotheses that plans are 'too far' from patients to have an influence. Continued attention to collecting plan-level data is warranted. Further work should address other possible sources of variations in HEDIS scores, such as variability in plan administrative databases.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
International Journal for Quality in Health Care
Authors
Laurence C. Baker

Can You Trust Your Doctor? Patients, Providers, and Health Reforms in China

-

In this colloquium, we hear about Tsinghua University researchers' studies on physician-patient trust and satisfaction with health care in China. Professor Shen describes her research on “Social distance and its impact on patients’ trust in their providers in transitional China.” Using 2008 data from over 3500 patients that includes unique measures of patient trust – such as whether or not patients followed doctor recommendations for treatment – Dr. Shen and colleagues find large differences in trust, with patients of lower socio-economic status displaying higher trust in doctors than other groups. Analyses also examine how trust is related to satisfaction with health services, and how patient dissatisfaction in China compares to that in other countries’ health systems. Related research explores patients’ and providers’ attitudes towards separation of prescribing and dispensing, a key component of the 2009 health reforms, and how patient mistrust of providers stems from concerns about both competence and profiteering from overprescribing.

Philippines Conference Room

Qunhong Shen

Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 723-4934 (650) 723-6530
0
Visiting Scholar, 2009-2010
Qunhong Shen Associate Professor Speaker Tsinghua University School of Public Policy and Management
Seminars

March 2010 Dispatch - The Politics of Pornography: Islamic Governance in Democratic Indonesia

Authors
James Hoesterey
News Type
News
Date
Paragraphs

Prominent Indonesian Muslim intellectual Nurcholish Madjid once declared “Islam Yes; Islamic political party No!” Voters in contemporary Indonesia seem to agree with this basic sentiment. Despite the recent Islamic revival that has dramatically increased public expressions of piety, Islamic political parties have failed to gain any significant electoral traction in Indonesia. In fact, between the 2004 and 2009 national elections, support for Islamic parties actually decreased from 38 percent to approximately 28 percent. Yet during those same five years, the Islamic political parties that failed to win at the ballot box mobilized enough political and popular support to pass one of Indonesia’s most divisive pieces of legislation—the Anti-Pornography Law. These seemingly contradictory elements of Indonesian politics provide starkly different impressions of Islam’s political role. Does a weak showing in the country’s electoral politics indicate the imminent demise of Islam in Indonesian politics? Or does the politically adept maneuvering of Islamists—who seek political power through legislation about bodily discipline—foretell gloomy days ahead?

Explanations for this paradox depend largely on where we look for “the political.” Political scientist Greg Fealy has described Islam in Indonesia as a mosaic. If we spend too much time focusing our gaze on one single area, he observes, we lose sight of other patterns elsewhere in the mosaic. To understand political Islam by ballot box alone is to miss the cultural undercurrents that have direct bearing on Islam and politics in Indonesia.

The anti-pornography bill was not only a political battle waged inside the parliament building; it was also a media drama that played out in the newspapers, televisions, and on the Internet. Human rights and women’s advocacy groups vehemently protested an early version of the bill, which stipulated that women would be prevented from leaving their homes during certain evening hours. From a different vantage point, the mostly Hindu island province of Bali threatened to secede, arguing that the article prohibiting “revealing” clothing in public would wreak havoc on the island’s tourism industry, still sluggish after devastating bomb attacks in 2002 and 2005. Whereas many non-Muslims worried about the “Islamization” of Indonesia, proponents of the bill lamented the “degradation of national morality.”

Popular Muslim television preachers were among the bill’s most vocal supporters. Eager to parlay their celebrity appeal into political clout, TV preachers Ustad Jefri Al-Buchori and Arifin Ilham helped to lead the so-called Million Muslim March to rally public support for the anti-pornography bill. Celebrity preacher and self-help guru Abdullah Gymnastiar led a sophisticated multimedia campaign to promote the bill through television, radio, the Internet, text messages, and public rallies. All of these popular preachers, in step with the political strategy of the Indonesian Council of Ulamas, invoked the religio-political language of moral crisis in an attempt to control the terms of political debate. Unable to win an election, Islamic groups flexed their moral muscle in the public sphere. From the pulpit of his Sunday afternoon television program, Gymnastiar characterized those against the bill as “having no shame” before God or country. Nearly every single political party, anxious not to appear “un-Islamic,” voted to support the anti-pornography legislation.

The political participation of a new generation of media-savvy religious leaders reveals a sentiment quite different from Nurcholish Madjid’s liberal aspirations. As one proponent of the Anti-Pornography Law put it, “Islamic political party No; Political Islam Yes!” Whereas utopian visions of the international caliphate may not resonate with Indonesian voters, it appears that political Islam—as played out on the public stage—is alive and well. What remains to be seen, however, is whether those who engage in the politics of piety also have the moral courage to champion Indonesia’s more pressing issues of poverty and corruption.

 

------------------

Shorenstein APARC Dispatches are regular bulletins designed exclusively for our friends and supporters. Written by center faculty and scholars, Shorenstein APARC Dispatches deliver timely, succinct analysis on current events and trends in Asia, often discussing their potential implications for business.

Hero Image
IndonesiaMosqueCropped
All News button
1

Visit by Czech Prime Minister Jan Fischer

Jan Fischer was born in Prague in 1951 to a family of mathematical statisticians and actuarial mathematicians. His father was a scientific employee of the Mathematics Institute of the Czech Academy of Science and devoted himself to statistical applications in genetics, breeding and medicine.

Fischer finished his studies at the national economics faculty of the University of Economics, Prague with a degree in statistics and econometrics in 1974. He joined the statistical office after university, where he worked until the beginning of the 1980s as a research employee of the Research Institute of Socioeconomic Information (then a part of the statistics office). In 1985, he finished his post-graduate studies at the Prague School of Economics and gained the title of Candidate of Science in the field of economic statistics. He served in various functions at the Federal Statistical Office until 1990, when he became deputy chairman of the office. After the creation of an independent Czech Republic in 1993, he became the deputy chairman of the Czech Statistical Office.

From the beginning of the 1990s he led teams processing the results of parliamentary and municipal elections. He was also in charge of contacts with the European Union's Eurostat statistical office. In the spring of 2001, he worked on a mission of the International Monetary Fund which examined the possibility of building statistical services in East Timor.

From September 2000 he worked as the director of the production department for the Taylor Nelson Sofres Factum company, and from March 2002 until his naming as chairman of the Czech Statistical Office, he was the head of the research facilities of the Faculty of Informatics and Statistics of the Prague School of Economics.

He was named chairman of the Czech Statistical Office by the President of the Czech Republic on 24 April 2003.

He was named Prime Minister by the President of the Czech Republic on 9 April 2009.

He is a member of a number of prestigious institutions, including the Czech Statistics Society, the International Statistics Institute, the Science Council, the Board of Trustees of the University of Economics, Prague, as well as the Science Council of the University of J.E. Purkyně in Ústí nad Labem.

Jan Fischer is married for the second time and is the father of three children.

Jan Fischer Prime Minister, Czech Republic; Chairman, Czech Statistical Office Speaker
Panel Discussions
Subscribe to Elections