Sunday, August 30, 2009

Need health Care? Emigrate

A few years back, when I was between tours as a correspondent in Asia my son asked me what I would do if I got sick, not having at the time an employer or any kind of private health insurance. Almost without thinking, I said I’d fly to Hong Kong, assuming I was well enough to get on an airplane.

On more sober reflection, I decided that this offhand remark had real possibilities. Hong Kong does not have universal health coverage, like many other countries, but it does have an excellent public hospital system. After living there for 16 years I was a permanent resident and thus eligible to use these services.

As Americans wrestle with health care, as the public debate gets more contentious, as the likelihood of the Congress enacting any kind of meaningful public health care fades, people need to think about their options. Here is my modest proposal: emigrate. In other words, move to another country that offers better health care.

Certainly, there are plenty of countries to choose from. Almost every developed country in the planet has some forms of universal coverage. What about New Zealand? It is a nice, green country, about the size of Britain with only 4 million people, very welcoming to immigrants, low crime and stunning views.

It also has a universal health care system generally paid for through taxation. Treatments are usually free or at least subsidized. There is also an option to obtain private medical insurance too. The New Zealand system is, in fact, very similar to that in Britain.

For several years I’ve been living in Japan, where I am covered by Japan’s universal national health insurance policy. All residents are covered without regard to medical preconditions or actuarial risk. The premium is graduated to the ability to pay. I just returned from my annual check-up, which is free, being paid for by the city I live in.

Of course, there is an option closer to home: move to Canada. A few years ago a friend of mine with some serious health problems, told me he was thinking of emigrating to Canada because of its comprehensive health care system. At the time I was rather shocked to hear him; now that I’m older it doesn’t seem so shocking.

One country to avoid is the People’s Republic of China. It seems to me that of the major countries in the world, China most closely resembles the U.S. in its health care policies. This seems counter-intuitive. Aren’t communist countries supposed to provide free health care?

How many times do you hear that Cuba or China or whomever may be repressive but at least the health care is free? The repressive part about China is true, but the medical care is not free.
China used to have a rudimentary free health care system. It was part of what we call the cradle-to-grave welfare and what the Chinese call the “iron rice bowl”. But with the market reforms begun in 1978 the iron rice bowl is broken, and hasn’t really been repaired. Most Chinese have to pay for their health care out of their pocket.

There is, of course, a catch. It isn’t usually enough just to visit these countries to be covered by their national plans. You have to become a citizen, or at least obtain long term residency. That means, at the least, of undergoing the hassle of obtaining a work permit to live in the country long enough to obtain residency.

This of course, does not negate the possibilities of “medical tourism”. That is, flying to another country on a tourist visa and checking into the hospital there. You have to pay the fee up front, but it is often a fraction of the cost of the same kind of care in the U.S. Thailand is a particularly attractive destination for elective surgeries of all kinds. So too are South Korea and even India.

I lived in Hong Kong in the years that led up to the handover of the former British colony to China in 1997. During those years thousands of middle-class Hong Kongers moved to Canada, Australia and to some extent the U.S. to obtain citizenship, denoted by obtaining a Canadian, Australian, etc. passport.

They had no real desire to actually live in those countries, and having obtained the coveted passport, they then returned to Hong Kong and resumed their normal lives. They looked on their shiny new travel documents as a kind of “insurance policy,” insurance that they had a bolt hole to go to should things turn out bad post 1997.

Perhaps one can view Canada, and possibly some other countries, as a new kind of bolt hole for medically disadvantaged Americans. In that case the idea of a foreign passport as a kind of “insurance policy” may take on a different kind of meaning.

Monday, August 17, 2009

Down to the Wire

Election campaigning for Japan’s general election officially opened Tuesday, but you would hardly know it. The two main and several smaller parties vying for votes have been campaigning furiously since mid-July when Prime Minister Taro Aso dissolved the Diet (parliament) and set August 30 as the day of reckoning.

The leaders of the two main parties, Aso of the Liberal Democratic Party (LDP) and Yukio Hatoyama leader and prime minister candidate for the Democratic Party of Japan (DPJ), have already had televised debates with each other and with leaders of several smaller parties.

The sound trucks have been patrolling my neighborhood for the past two weeks. For that matter, posters featuring faces of the local candidates or the party leaders have been plastered on walls and neighborhood houses since I moved to Japan from Thailand nearly two years ago.

The electioneering will reach a frenzy over the next week or so with more sound trucks, more politicians, wearing sashes with their name on it greeting commuters going to and from work at the railroad stations, more election flyers stuffed in mailboxes..

Japanese are at least spared the endless “attack” advertisements on television as is the case in the U.S., since paid advertisements on radio and television are banned. The candidates make their case on unpaid televised public forums and by haranguing voters at railroad stations, the main public space in urban Japan.

The politicians however, have found a loop-hole in the election law that permits them to air what look suspiciously like attack advertisements over the Internet. In a recent YouTube video produced by the LDP, a young man woos his girlfriend with promises about a life free or worries about child care and retirement.

The woman wonders how her suitor is going to pay for all these goodies, while he tells her not to worry. He will sort out the details later after they are married. It is a clever play on the DPJ party manifesto, which calls for generous government benefits childrearing and is generally vague on how to pay for them.

Each party has issued its election platform, or manifesto, as it is called here. It is not certain whether Japanese voters are swayed by these platforms any more than most Americans are persuaded by their party platforms, but it does give the candidates something to talk about. The LDP has zeroed in on the several generous promises made in the DPJ manifesto along with its fairly vague proposals to finance them.

The Democrats propose that the government provide a monthly stipend of about $250 per month per child until graduation from junior high school, providing free high school education and the abolition of highway tolls. The proposals would “bankrupt” Japan, says Hiroyuki Hosoda, secretary general of the LDP.

Some others would argue that these comments are pretty rich coming from the party which has spent its way into the greatest per capital budget deficit of any developed nation on the planet, a public debt that is estimated at about 180 percent of gross domestic product.

Despite all of the sound and fury – not just a metaphor considering the sound trucks patrolling residential neighborhoods blasting out the name of the candidate over and over are the principal means of campaigning in Japan – the public opinion polls showing the LDP headed for defeat have not budged in the past two weeks.

Prime Minister Taro Aso is putting up a brave fight, but a victory in this election would be somewhat akin to former U.S. President Harry Truman’s surprise victory in the 1948 presidential election. But he and his party did catch a break with the first definitive news of impending economic recovery, which might take some of the wind out of the opposition sails.

The country’s gross domestic product grew at nearly one percentage point in April-June, compared with the sickening eleven percentage point drop the previous quarter. It works out to an annualized growth rate of around three percentage points. Aso, of course, was quick to argue that the news vindicated the stimulus measures his government has taken.

It has taken Japan a long time to come to this point where it is on the brink of a genuine two party system, one in which two parties, one a little left of center the other a little to the right, alternate in power. Japan is the only major democracy in the world that has not experienced a change of government through the ballot box.

In a larger sense, Japanese politics have reached that stage already in that two political entities with roughly equal political strength are fighting it out openly, are having policy debates, publishing manifestos and touring the country to try and sell the voters on their point of view.

For the opposition Democrats, there remains the one final hurdle in persuading the conservative Japanese public that they can be trusted with power. Should Japan stick with the known or take a leap into the unknown and turn the keys to government over to another political party? And if they can’t do it now, when can they do it?

Wednesday, August 12, 2009

Super Agent Clinton

One should not discount the intelligence value of former president Bill Clinton’s recent visit to North Korea to help secure the release of two American journalists accused of entering the country illegally on a reporting mission.

One of the most burning questions about North Korea is the health of “Dear Leader” Kim Jong-il, and its impact on the question of succession and ultimately the future stability of North Korea. So far, all speculation concerning Kim’s health has come from studying recent photographs, where he has looked gaunt for several months.

In the recent meeting, however, Clinton and several members of his entourage meet Kim face-to-face over several hours, where they were able to observe him close up and in person. In a country where it is virtually impossible to obtain “humint” - human intelligence - this was no small thing.

True, Clinton is not a trained physician, but it is hard to imagine that he was not thoroughly prepped to look for signs of disability. Did Kim walk with a shuffling motion? Were his words slurred? His eyes blood shot? How firm was his handshake, assuming they shook hands?

There may well have been a physician tucked away somewhere on Clinton’s entourage, even if not formally included in the list of visitors. He might have been included, ostensibly to examine the health of the two journalists after five months of detention. Or, for that matter, to care for Clinton himself – after all, he is a former president.

I imagine U.S. intelligence agents must have welcomed the priceless debriefing and peek into on the state of Kim’s health, mind and regime from America’s most seasoned diplomatic players and master of political psychology.

North Korea faces the real prospect of collapsing into anarchy after the death of the visibly ailing leader Kim Jong-il despite reports emanating from South Korea’s intelligence services, though not officially confirmed in Pyongyang, that Kim had anointed his twenty-something third son, Kim Jong-un, to be his successor.

When Kim Jong-il succeeded his father, the country’s founding president Kim Il-sung, he was dismissed as a lightweight. Compared with his bear of a father, the younger Kim seemed physically unprepossessing. It was thought that he was only interested in making movies and courting starlets. Soon he would fall from power and the country would collapse. All one had to do was sit back and wait.

In fact, Kim Jong-il had been slowly consolidating power for some two decades before he assumed office on his father’s death in 1994. He may well have liked to watch movies, but his father made sure that he was thoroughly grounded in communist party affairs. Soon after graduating from university, for example, he joined the Organization and Guidance Department of the Korean Workers’ Party.

In the ensuing years he was a vice director of the party’s central committee, then secretary of the central committee. By 1980, when the senior Kim was 68 – about the same age as Kim Jong-il is now – the younger Kim was already being addressed as the “Dear Leader” and designated the official heir apparent. From then on he and his father were often photographed together.

Moreover, Kim Il-sung had fourteen more years of life in which to groom his successor. During that time the younger Kim was appointed supreme commander of the armed forces, though he had little or no military experience. Pictures of Kim with former U.S. president Jimmy Carter taken during the latter’s visit in 1994 show a seemingly robust man, of 82 (though he would die of a heart attack one month later).

It seems highly unlikely that Kim Jong-il will live into his 80s as he is reputed to be suffering from (depending on sources) diabetes, strokes or pancreatic cancer. So he is far behind the power curve in preserving the Kim family dynasty on two counts: He has done little or nothing, it appears, to groom his chosen successor, assuming he has one, and he may not live long enough to make up for lost time.

Almost nothing is known about Kim Jong-un. There are no photographs with his father, indeed no current photographs at all. By some sources he was appointed to the party’s Organization Guidance Department for some seasoning, like his father. Other sources claim it is the National Defense Council.

The Korean propaganda apparatus are beginning to build up the youth they have dubbed the “brilliant comrade”, but we are still left with reality a callow youth in his twenties, who’s only known accomplishment was to attend a boarding school in Switzerland.

Do the tough generals in North Korea who run nuclear and other programs have enough loyalty to the Kim family to fall behind him? Or, as is likely, can we expect more uncertainty and turbulence and possibly descent into anarchy?

Those are questions not easily discerned from the usual “North Korea watching” methods of studying official pronouncements and mulling over official photographs. That’s why any kind of engagement is valuable, even if it does not lead directly to diplomatic breakthroughs.

Sunday, August 02, 2009

Two Giants of Democracy

There was a distinct feeling of the passing of an era this past week with the death of former Philippine president Corazon Aquino. Meanwhile, former president Kim Dae Jung was reported to be under intensive care in a Seoul, South Korea hospital.

As of this writing, Kim seems to be holding on to life, but he has bronchial pneumonia, which is a pretty dangerous thing for a man of 85. Together with the younger Aung San Suu Kyi of Myanmar, they constituted the troika of democratic opposition to dictatorial rule in Asia.

For most of her adult life Cory, as she was known to everyone, was, as she always called herself, a simple housewife and helpmate to her husband Benigno Aquino, mayor, governor, senator and symbol of opposition to the iron rule of Ferdinand Marcos.

That changed suddenly in 1983 when, on returning from exile in the United States, Aquino was assassinated on the tarmac of Manila’s international airport by agents of the Marcos regime. In 1986 Cory ran for president against Marcos. Both claimed victory and Cory soon ousted Marcos in the famous “People Power” revolt.

She assumed power by the simple expedient of taking the oath of office and behaving as if she were the duly elected president. The armed forces and the powerful Roman Catholic Church moved behind her, and soon Marcos was on a flight to political retirement in Hawaii.

For Kim achieving the presidency was the culmination of a lifelong struggle. After two unsuccessful attempts, he won his first seat in parliament in 1961, only to find the National Assembly building surrounded by tanks in the military coup that brought Park Chung Hee to power three days later. In 1971 he made the first of four bids for president — running against Park himself.

He engendered Park’s undying enmity by winning as much as 46 per cent of the vote. In that first presidential campaign he was hit by a car, perhaps deliberately, and suffered an injury that made him walk with a shuffle for the rest of his life.

In 1973 he was abducted by agents of the Korea Central Intelligence Agency (KCIA) in Japan and brought back to South Korea forcefully. His political rights were restored shortly only after Park’s assassination in 1979.A year later Kim was accused of treason after students and residents of the southwestern city of Kwangju rose in a bloody insurrection.

In all, Kim spent five years in prison, seven under house arrests and two years in exile in the United States. Returning to Korea in 1985, he and his supporters had Aquino’s assassination two years previously strongly in mind. A couple of U.S. congressmen accompanied him to discourage any “copy cat” killings.

In the 1997 election Kim Dae Jung proved he was not only courageous but could also be shrewd, practical, even ruthless when he had to be. His comeback, which marked the first peaceful transfer of power from a ruling to an opposition party in South Korea's history, was a masterpiece of political manipulation.

He made an alliance of convenience with the conservative Kim Jong Pil, the very man who had masterminded the coup that prevented him from taking his assembly seat more than 30 years before and the founder of the KCIA, the agency that had tried to kidnap him.

He leaked allegations that the sons of his main opponent, Lee Hoi Chang, had avoided military service. These revelations, damaging enough to Lee, encouraged the ambitious mayor of Inchon, Rhee In Je, to enter the race, thus splitting the conservative vote and allowing Kim to squeak into power with about 40 percent of the vote.

As president, Kim Dae Jung showed toughness in getting his way with the legislature and Korea's large business conglomerates, but he also steadfastly held to his vision of reconciliation with North Korea, known as his "sunshine policy." He was rewarded with the Nobel Prize for Peace for his summit meeting with Kim Jong Il in Pyongyang in 2000.

Some of the luster went off of that achievement when it was later revealed that he had arranged with several large business conglomerates to bribe the North with about $500 million in cash to hold the meeting in PyongyangThere was personal sadness two when his two sons were accused of corruption.

These days the sun does not shine so brightly on the sunshine policy. A cold wind continues to blow from Pyongyang. The election of conservative Lee Myung Bak as president (another peaceful change of power) reflected growing disillusion in South Korea. Still elements, such as the Kaesong industrial zone across the Demilitarized Zone, remain in place.

Cory’s term as president was marked by half a dozen coup attempts. In one instance she was falsely accused of hiding under her bed in the presidential palace. “We’re Sorry Mrs. President!,” ran the subsequent headline of an apology printed in the Philippine Enquirer.

Probably her greatest achievement as president was the writing of the new 1987 Constitution, which has withstood many challenges and the closing of the two big American military bases without breaking the alliance and the enduring friendship. Some were disappointed that she was not the miracle worker who could bring her country out of poverty by herself.

Philippine democracy has endured with some fits and starts. A low point was the faux people Power reprise in 2001, which ousted the democratically elected Joseph Estrada and replaced him with and the incumbent Gloria Arroyo, who has been dogged throughout her tenure by questions of legitimacy.

In the Philippines Cory was obviously boosted by the late archbishopof Manila Cardinal Jaime Sin and by the then commander of the paramilitary police, Fidel Ramos, who succeeded Cory as president and also helped cement the country’s democracy up with a successful term.

There are, of course, other Asian democrats of note, including Martin Lee of Hong Kong and former president Kim Young Sam, a longtime democracy activist in his own right, who became in 1993 Korea's first elected civilian president in decades. But Cory Aquino and Kim Dae Jung are in a class by themselves.