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Taiwan’s January presidential election is an important milestone in an evolving geopolitical shift in East Asia characterized by a growing Chinese regional military advantage, increased Chinese military and economic coercion vis-à-vis Taiwan and other neighbors, and simmering confrontation between China and the United States who see each other as primary strategic competitors. U.S. strategy leans heavily on allies in East Asia, particularly Japan, through initiatives that aim to bolster allied military cooperation and coordinate economic security policies related to supply chains, export controls, and other measures that are important to a vibrant and international technology hub like Silicon Valley.

What are the key dynamics at play in this regional competition over power, influence, and Taiwan’s future? How should we assess efforts to adapt the U.S.-Japan security and technology alliance to meet these challenges, and what might be China’s response? What should we look for in 2024 given the Taiwan election results and political uncertainty in the United States and Japan? Our panel will feature experts on these issues to provide their views and engage in discussion with the audience.

This in-person event is co-sponsored by Sasakawa Peace Foundation USA.
Lunch will be provided.

Speakers:

Portrait of Hesham Sallam

Larry Diamond is the Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies and the William L. Clayton Senior Fellow at the Hoover Institution. He is also the founding coeditor of the Journal of Democracy and serves as senior consultant (and previously was co-director) at the International Forum for Democratic Studies of the National Endowment for Democracy. During 2002-3, he served as a consultant to the U.S. Agency for International Development (USAID) and was a contributing author of its report Foreign Aid in the National Interest. He has also advised and lectured to the World Bank, the United Nations, the State Department, and other governmental and nongovernmental agencies dealing with governance and development.

At Stanford University, Diamond is a professor by courtesy of political science and sociology at Stanford University, where he teaches courses on comparative democratic development and post-conflict democracy building, and advises many Stanford students.

Headshot photo of Matake Kamiya

Matake Kamiya is currently a professor of international relations at the National Defense Academy of Japan (Japan’s primary military academy). He is also vice president at the Japan Forum on International Relations, an adjunct research fellow at the Japan Institute of International Affairs, a member of the research committee of the Research Institute for Peace and Security, and president of the Japan Association for International Security.

His current research interests include the US-Japan security relations, the future of the liberal international order, Japanese foreign and security policies, the Indo-Pacific security, and nuclear issues including Japan's(non-)nuclear policy. He has been serving as the leader of the Japan-US joint research project on “China Risk and China Opportunity” since 2017. 

Square headshot photo of Oriana Skylar Mastro

Oriana Skylar Mastro is a Center Fellow at the Freeman Spogli Institute for International Studies and Courtesy Assistant Professor of Political Science at Stanford University where her research focuses on Chinese military and security policy, Asia-Pacific security issues, war termination, and coercive diplomacy. She was previously an assistant professor of security studies at Georgetown University. Mastro continues to serve in the United States Air Force Reserve as a strategic planner at Indo-Pacific Command. For her contributions to U.S. strategy in Asia, she won the Individual Reservist of the Year Award in 2016 (CGO) and 2022 (FGO).

Headshot photo of Jim Schoff

Jim Schoff is senior director of the “US-Japan NEXT Alliance Initiative” at Sasakawa Peace Foundation USA (based in Washington, DC) that mixes bilateral dialogue, research, and public-private engagement to help prepare the alliance for new challenges in an increasingly complex and fluid geostrategic environment. Previously, Schoff was a senior fellow and director of the Japan Program at the Carnegie Endowment for International Peace for nine years, following two years as senior adviser for East Asia policy at the US Office of the Secretary of Defense. Schoff’s career spans thirty-five years working in the fields of business, education, government, and the non-profit sector, all related to Japan, East Asia, and the US-Japan alliance. 

Moderator:

Kiyoteru Tsutsui

Kiyoteru Tsutsui is the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies at Shorenstein APARC, the Director of the Japan Program and Deputy Director at APARC, a senior fellow of the Freeman Spogli Institute for International Studies, and Professor of Sociology, all at Stanford University. Tsutsui received his bachelor’s and master’s degrees from Kyoto University and earned an additional master’s degree and Ph.D. from Stanford’s sociology department in 2002.

Tsutsui’s research interests lie in political/comparative sociology, social movements, globalization, human rights, and Japanese society. His most recent publication, Human Rights and the State: The Power of Ideas and the Realities of International Politics (Iwanami Shinsho, 2022), was awarded the 2022 Ishibashi Tanzan Award and the 44th Suntory Prize for Arts and Sciences.

Kiyoteru Tsutsui
Kiyoteru Tsutsui
Larry Diamond Senior Fellow Center on Democracy, Development, and the Rule of Law, Stanford
Matake Kamiya Professor of International Relations, adjunct research fellow Japan Institute of International Affairs
Oriana Skylar Mastro Center Fellow Walter H. Shorenstein Asia-Pacific Research Center
Jim Schoff Senior Director Sasakawa Peace Foundation USA
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Japan Program Postdoctoral Fellow, 2023-2024
Hikaru_Yamagishi.png
Ph.D.

Hikaru Yamagishi joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as Japan Program Postdoctoral Fellow for part of the 2023-2024 academic year. She received her Ph.D. in Political Science from Yale University in 2022, and most recently was a Postdoctoral Research Fellow at the Program on U.S.-Japan Relations at Harvard University's Weatherhead Center for International Affairs. Her research focuses on democratic institutions and electoral competition, with a special interest in the case of Japan.

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Shorenstein APARC's annual report for the academic year 2022-23 is now available.

Learn about the research, publications, and events produced by the Center and its programs over the last academic year. Read the feature sections, which look at Shorenstein APARC's 40th-anniversary celebration and its conference series examining the shape of Asia in 2030; learn about the research our postdoctoral fellows engaged in; and catch up on the Center's policy work, education initiatives, publications, and policy outreach. Download your copy or read below:

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George Krompacky
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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. 
 

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Striking the Right Balance: What South Korea Can Do to Enhance Deterrence in the Taiwan Strait

Despite obstacles and risks, there are good reasons why South Korea should want to increase deterrence against China. In a new article, Center Fellow Oriana Skylar Mastro and co-author Sungmin Cho chart an optimal strategy for Seoul to navigate the U.S.-China rivalry and support efforts to defend Taiwan.
Striking the Right Balance: What South Korea Can Do to Enhance Deterrence in the Taiwan Strait
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Despite changes in China’s forces and the illegal invasion of Ukraine, the United States does not need to increase the numbers of its nuclear arsenal, argues Oriana Skylar Mastro in a new report.

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Banner image for October 12, 2023 APARC event Political Economy of the Financial Crisis in Japan and the U.S. featuring headshot of speaker Hirofumi Takinami

 

This spring, we saw the collapses of Silicon Valley Bank, Credit Suisse, etc., and now we are observing collapses of Chinese real estate giants: Evergrande, and Country Garden. Would be there another financial crisis? 
Now, it is highly worthy to review the ‘lessons' of historically recent financial crises with significant seriousness, which happened in the two largest economies, the United States and Japan.

During the 1990s-2000s, Japan and the United States each experienced the same type of financial crisis, notably triggered by the collapse of major financial institutions, stemming from the real estate bubble burst. Namely, the Heisei Financial Crisis and the Lehman Brothers Collapse.

Both were under the political-economic conditions of one of the largest economies in the world, as well as of an advanced democracy. Enormous shock happened politically, economically, and historically, due to these two financial crises.

Then, as the research question, what were the ‘lessons’ of the United States and Japan's financial crises, concerning crisis response through public money injection, from the viewpoint of political economy? Where is the ‘learning’ between Japan and the United States?
Also, as the related research ‘puzzle’, why the difference in speed between these countries to respond and recover?

Based on his Ph.D. thesis, Senator Takinami, an alumnus of Stanford APARC, will elaborate on these issues by covering up and amending Hoshi & Kashyap(2010), thus establishing ‘7 lessons’ throughout the Japan and the United States financial crises on government bailout from the political economy viewpoint.

 

Speaker

Square photo portrait of Hirofumi Takinami

Hirofumi Takinami (Ph.D.) is an Upper House Member of the Japanese Parliament, corresponding to a Senator in the U.S. He is a former Vice-Minister of Economy, Trade, and Industry, and also a former Vising Scholar, APARC, Stanford University. 

Dr. Takinami covers a wide range of policies, including not only energy, environment, and finance, but also innovation, infrastructure, welfare for the disabled, etc. He has been the Director of the Fisheries Division of LDP (Liberal Democratic Party) from last year.

Before starting his political career 10 years ago, he was a Director of the Ministry of Finance. During his about 20 years of service as a Japanese government official, he held management positions including Public Relations Director, and Deputy Budget Examiner at the Ministry of Finance. He also worked internationally, in charge of the Asia-Pacific Economic Cooperation (APEC) and the Asia Europe Meeting (ASEM) etc. 

He graduated from the University of Tokyo in 1994, earning a Bachelor of Law. He received a Master of Public Policy (MPP) from the University of Chicago in 1998. While in office as an upper house member, he obtained a Ph.D. in 2021 from Waseda University for the study on financial crises, which he started when he held research positions at Stanford University as a Visiting Fellow in 2009-2011 and as a Visiting Scholar in 2016. 

Hirofumi Takinami Upper House Member of Japanese Parliament, Ph.D. , Former Vising Scholar, APARC, Stanford University Upper House Member of Japanese Parliament
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APARC Deputy Director and Japan Program Director Kiyoteru Tsutsui recently joined Nippon TV host Atsushi Tamura for a conversation in an episode of the series "Another Sky."

The conversation included an overview of Tsutsui’s research on international human rights, the reasoning behind his decision to study human rights as a sociologist, and other topics. One issue that Tsutsui identified over the course of the interview is the tension between international human rights institutions and the vested interests of powerful governments, a topic that he addresses in his award-winning book Human Rights and the State (Iwanami Shinsho, 2022). The book received the 44th Suntory Prize for Arts and Sciences and the Ishibashi Tanzan Prize and was recognized by the Shinsho Taisho Award.

Tsutsui's book traces the origins and evolution of universal human rights principles and the establishment of a human rights framework that curtails the influence of nations averse to external involvement in their domestic matters. In it, Tsutsui examines the effectiveness of international human rights since the collapse of the Cold War system and examines the quality of Japan's human rights diplomacy and education.

Watch the full interview below:

Kiyoteru Tsutsui

Kiyoteru Tsutsui

Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies at Shorenstein APARC, Director of the Japan Program and Deputy Director at APARC, Senior Fellow at FSI, and Professor of Sociology
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The Cost of the "Taiwan Contingency" and Japan's Preparedness

The ultimate choice that must be made.
The Cost of the "Taiwan Contingency" and Japan's Preparedness
Kiyoteru Tsutsui
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Despite the Popularity of Manga and Anime, Kiyoteru Tsutsui Feels the Decline of Japanese Studies in the United States

Professor Kiyoteru Tsutsui, a recipient of the Suntory Prize for Arts and Letters and the Ishibashi Tanzan Prize, is a member of the third cohort of the U.S.-Japan Next Generation Network, an exchange program of policy experts from the United States and Japan launched in 2009 by the Mansfield Foundation in the United States in cooperation with the Japan Foundation. As a participant in the network, he explores the state of Japanese studies in the United States.
Despite the Popularity of Manga and Anime, Kiyoteru Tsutsui Feels the Decline of Japanese Studies in the United States
A young professional woman standing in a city street, holding a notebook and talking to unseen audience.
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The Japanese Public Supports Women’s Leadership More Than Japan’s Global Gender Ranking Suggests

Contrary to current levels of women’s under-representation in leadership positions in Japan, the Stanford Japan Barometer, a new periodic public opinion survey co-developed by Stanford sociologist Kiyoteru Tsutsui and Dartmouth College political scientist Charles Crabtree, finds that the Japanese public favors women for national legislature and corporate board member positions.
The Japanese Public Supports Women’s Leadership More Than Japan’s Global Gender Ranking Suggests
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APARC Deputy Director and Japan Program Director Kiyoteru Tsutsui joins Nippon TV host Atsushi Tamura on an episode of "Another Sky" to share his work on international human rights and discuss his most recent book, "Human Rights and the State."

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Melissa Morgan
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This September, President Biden welcomed Prime Minister Fumio Kishida of Japan and President Yoon Suk Yeol of South Korea for a weekend summit at Camp David. Against the backdrop of the war in Ukraine and tensions between the U.S. and China over trade, militarization, and Taiwan, the meeting was a notable step in ongoing efforts by the U.S. to increase trilateral cooperation amongst its allies in East Asia.

To contextualize the summit and its implications for the U.S.-South Korea-Japan relationship, Gi-Wook ShinDaniel SneiderThomas Fingar, and Oriana Skylar Mastro — scholars at the Freeman Spogli Institute for International Studies (FSI) and Walter H. Shorenstein Asia-Pacific Research Center (APARC) — explain the evolution of the relationship and how the summit may impact the dynamic moving forward.



A Complicated History


While South Korea and Japan are both long standing partners and allies with the United States, their bilateral relationship with each other has historically been strained.

In an interview with Asia Experts ForumGi-Wook Shin, the director of the Walter H. Shorenstein Asia-Pacific Research Center (APARC) explained:

“Japanese colonialism was instrumental to the formation of Korean national identity. The Korean peninsula is surrounded by big powers such as China, Japan, and Russia. Even today, these influences are still very strong. A sense of threat is still there.”

In particular, issues stemming from the Japanese occupation of the Korean peninsula between 1910 and 1945 remain a political third rail in both countries. The use of Korean nationals as forced laborers and soldiers in Japanese industry and the Japanese military remains an unresolved legacy, as do demands for the recognition of and restitution for Korean women who were taken into sexual slavery by the Imperial Japanese Army in the 1930s and 40s.

The withdrawal of Japanese troops from Korea, 1945.
The withdrawal of Japanese troops from Korea, 1945. | Mainichi Newspapers Company via Wikimedia Commons

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 KeizaiDaniel 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.

The war in Ukraine has done a lot to open leaders' eyes to the dangers of having neighbors with territorial hopes and claims that also have strong militaries. It's pushed these two countries to rethink their own strategies for security.
Oriana Skylar Mastro
FSI Center Fellow

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.”

South Korean President Yoon Suk Yeol, U.S. President Joe Biden and Japanese Prime Minister Kishida Fumio arrive for a joint news conference following three-way talks at Camp David.
South Korean President Yoon Suk Yeol, U.S. President Joe Biden and Japanese Prime Minister Kishida Fumio arrive for a news conference following three-way talks at Camp David. | Getty

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.   

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Stanford Next Asia Policy Lab team members at Encina Hall, Stanford
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New Stanford Next Asia Policy Lab to Tackle Emerging Challenges in Asia

Housed within the Walter H. Shorenstein Asia-Pacific Research Center, the lab will pioneer evidence-based policy research to help Asian nations forge pathways to a future characterized by social, cultural, economic, and political maturity and advance U.S.-Asia dialogue.
New Stanford Next Asia Policy Lab to Tackle Emerging Challenges in Asia
Portrait of Gi-Wook Shin and the cover of his book, 'The Adventure of Democracy."
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Urgent Choices: Stanford Sociologist’s Book Examines Korea's Path to Democratic Advancement and Global Leadership

In his new book, Gi-Wook Shin explores the challenges and possibilities for Korea's democracy and national vision for its future development.
Urgent Choices: Stanford Sociologist’s Book Examines Korea's Path to Democratic Advancement and Global Leadership
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The trilateral summit between the United States, South Korea, and Japan was an important marker in deepening coordination among the allies, but work still remains to create a solid security partnership.

Shorenstein APARC
Stanford University
Encina Hall, E301
Stanford,  CA  94305-6055

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Global Affiliate Visiting Scholar, 2023-24
Japan Patent Office
takumi_koganei.jpeg

Takumi Koganei is a global affiliate visiting scholar at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) for 2023-24. Koganei joined the Japan Patent Office (JPO) in 2014 and has worked as a patent examiner, handling patent applications mainly in the field of mechanics, including chip mounters, conveyors, and drone delivery systems. In 2019, he held the role of Chief of the supporting startup section in the Policy Planning and Research Division, where he supported startups in developing their intellectual property strategy with the help of IP experts. In 2020, he transitioned to the Patent Examination Department. In this role, he conducted patent examinations related to therapeutic devices like stents, surgical drills, and ablation devices. Furthermore, he was a member of the team that designed the patent classification for surgical support robots. After that, he transferred to the Ministry of Economy, Trade, and Industry (METI) as an Assistant Manager. In this capacity,  he served in the development of startup support measures for Japan's medical device industry from 2021 to 2023. 

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Front cover of the book "Who Shall Live?"
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Since the first edition of Who Shall Live? (1974), over 100,000 students, teachers, physicians, and general readers from more than a dozen fields have found this book to be a reader-friendly, authoritative introduction to economic concepts applied to health and medical care.

Health care is by far the largest industry in the United States. It is three times larger than education and five times as large as national defense. In 2001, Americans spent over 12,500 per person for hospitals, physicians, drugs and other health care services and goods. Other high-income democracies spend one third less, enjoy three more years of life expectancy, and have more equal access to medical care.

In this book, each of the chapters of the original edition is followed by supplementary readings on such subjects as: "Social Determinants of Health: Caveats and Nuances", "The Structure of Medical Education — It's Time for a Change", and "How to Save 1 Trillion Out of Health Care".

The ten years following publication of the 2nd expanded edition in 2011 were arguably more turbulent for US health and health care than any other ten-year period since World War II. They span the implementation of the Affordable Care Act, the deepening opioid epidemic, and the physical, psychological, and socio-economic traumas of the COVID-19 pandemic.

An important new contribution to this book is to describe and analyze the changes in five sections: "The Affordable Care Act and the Uninsured", "Health Care Expenditures", "Health Outcomes", "The COVID-19 Pandemic", and "Health and Politics". This part includes 24 tables and figures.

This book will be welcomed by students, professionals, and life-long learners to gain increased understanding of the relation between health, economics, and social choice.

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Health, Economics and Social Choice

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Karen Eggleston
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World Scientific
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