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It seems that Trump's lousy polling and chaotic campaign mean Clinton will win in November. Most assume we can then relax: we know Hillary Clinton from her time at State, and she will be reassuringly orthodox – more orthodox indeed than Barack Obama. US foreign policy will be back to 'normal': a strong military, robust alliances, free trade and decisive interventions wherever the US-led global order is challenged.
Well, maybe, but don't bet on it. Predictions of the kind I'm about to make are inherently fallible, but there do seem good reasons to question our confidence here. The 2016 Presidential campaign has changed the landscape of US politics in ways that will resonate long after November, and impose big new pressures and constraints on Clinton's approach to many issues, including foreign policy. We can see how these pressures will work if we put ourselves in Clinton's shoes and reflect on what will most likely be her top priority from the moment she becomes President: re-election for a second term in 2020.
The events of 2016 mean her biggest threat in 2020 will come from her own side. To see the scale of this threat, imagine what would have happened this year if her rival for the nomination had not been Bernie Sanders but, say, Elizabeth Warren. If someone as unlikely as Sanders could run Clinton so close, imagine what a more poised, articulate, electable, female Presidential candidate like Warren would have done. It's a fair bet that she would have beat Hillary to the nomination, and, against Trump, be set to win the Presidency. She must be kicking herself.
So already Clinton must worry that Warren, and others like her, will be thinking about challenging her for the Democrat nomination 2020. Normally, of course, an incumbent can expect to be nominated unopposed for a second term, but these are not normal times. And Clinton is not quite a normal candidate. If she proves as uninspiring and lacklustre in office as she's been in the campaign, and if she sticks to polices which so many of her party so obviously reject, she will be very vulnerable.
No one will be more aware of this danger than Clinton herself, and from Day One it will shape her policies – including her foreign policies. She is after all a professional politician through and through. There is no evidence that she has ever allowed foreign-policy convictions to override political calculations, and no reason to think this will change now.
That means we should expect Clinton to shape her foreign policy to neutralise the threat to her nomination in 2020 from the left of her party. So forget Hillary the hawk. To consolidate her Democrat base she will be even more cautious abroad than Barack Obama has been.
And she will be able to do that all the more easily because of what's happening on the Republican side of the aisle. Even if the GOP rebounds swiftly from the defeat that now looms, it will be a very different party, especially on foreign policy. Trump's success has revealed how vulnerable the party's Reagan/Bush/McCain orthodoxy is to his 'America First' brand of muscular isolationism.
Ambitious Republicans looking to 2020 must already be sketching for themselves a foreign policy stance that captures this appeal while avoiding Trump's many negatives. So Clinton will face much less pressure from the traditional right on foreign policy than she ever has before.
So what might we see instead? On trade, we can assume her repudiation of the TPP is permanent, and the temptation to step back from free trade to protect US jobs will grow much stronger. It will mean lower defence spending, and less willingness to bear costs and risks to reassure allies. It might mean for example, that a President Clinton would disappoint those who hope and expect that she would reverse a last minute No First Use declaration by President Obama.
It would mean no big new initiatives or commitments in the Middle East, and great caution about allowing strategic rivalry with China or Russia to grow. It would mean, in other words, a continuing and perhaps even accelerating stepping back from the muscular global leadership which has been the core of what Obama so memorably called 'the Washington Playbook'. It would mean that US allies like Australia would need to reassess their assumptions about American power – perhaps not as quickly as if Trump wins, but very thoroughly nonetheless.
We will need to remember that two very different kinds of bad outcome loom in Asia: one where the US and China becomes bitter rivals or even go to war, the other where America's influence in Asia swiftly declines. The only kind of good outcome is one where America avoids both war and withdrawal. That's got to be possible, but America's next president seems less and less likely to be able to get there.
Photo by Melina Mara/The Washington Post via Getty Images
Thanks to Kurt Campbell for his prompt and thoughtful response to my review of his recent book The Pivot. Kurt's post helps to clarify the key areas of difference between our views on the nature of America's policy challenge in Asia today, and the adequacy of the Pivot policy as a response to that challenge.
First, Kurt is right that I do think that it is all about China. Of course, as he says, Asia must manage many other issues to ensure its future prosperity and security, but history tells us plainly that none of these other issues can be successfully addressed without a stable regional order based on a robust agreement between major powers about their respective roles in that order.
There is no such agreement in Asia today between America and China. China no longer accepts US primacy, and seeks instead to establish a primacy of its own, while America remains determined to preserve its regional leadership. Until this fundamental clash of objectives is resolved, our chances of addressing any of these other problems are poor. One need only note as an example how trade and investment issues like the TPP and the AIIB have become hostage to strategic rivalry.
Moreover, as long as US-China rivalry in Asia is unresolved, the risk of war — including a major and even nuclear war — will remain high and perhaps continue to grow. This is by far the most serious risk that Asia faces, and Kurt is quite right to say that I take it very seriously. I believe that minimising this risk must be a first-order priority for everyone engaged in debating, deciding and executing strategic policy in Asia. And frankly, for all the talk of the Thucydides Trap, I do not think enough people in the US policy community recognise the scale of the risk or the imperative to avoid it.
Kurt is not right, however, to say that I see the only way to avoid a US-China war is for America to withdraw, leaving Asia under Chinese hegemony. I have repeatedly argued [for example in The China Choice] that the key to understanding Asia's strategic future is to recognise that there are not just two possible futures, but three. It is perfectly possible, and highly desirable, for the US to continue to play a major strategic role in Asia on a basis that China is willing to accept, and which therefore avoids escalating strategic rivalry and reduces the risk of war.
Kurt agrees with this, but his ideas about how it can be done seem to differ from mine. Read More
If that is not right, the Kurt needs to explain how it is different. If it is right, and his 'Operating System' is just US primacy under a new name, then it only works to promote a stable US-China relationship if China changes its mind and decides to accept US primacy after all. This hope has been the essence of the Pivot policy has all along — the hope that China, confronted with a display of US resolve, will drop its challenge and things will go back to the way they used to be. But nothing that has happened since the Pivot was launched five years ago suggests that this going to happen.
And why should we expect it to? Kurt suggests, as many others do, that China should and will acquiesce to US primacy in future because it has accepted and benefited from US primacy in the past. But China has changed a lot from the country that accepted US primacy in 1972. It has more power, bigger ambitions and a very different sense of its interests and opportunities than it had back then.
Kurt concludes his post by saying that I hold 'a subtly disguised view that the US is simply not up to the task of managing relations with China'. That's not quite right. I do think that America no longer has the power to sustain primacy in Asia if China is determined to resist. But I do think America is perfectly capable of negotiating a stable, productive bilateral relationship with China which preserves a strong US role in Asia, constrains China's hegemonic tendencies, and makes a vital contribution to the region's future — as I have explained in some detail in The China Choice.
I do however think that the US policy community has, with few exceptions, failed so far to understand the nature or the scale of the challenge it faces in negotiating that kind of relationship with China. In part I think that is because many of them seem, like Kurt, to see the question as a test of national character: a question of whether America will show that it's tough by 'persevering', or show weakness by 'punting'.
But is this the right way to see it? Wouldn't we be wiser to see the issue as a test of judgement; whether America can intelligently assess its options, weigh the costs and risks, and prudently choose a course of action that serves its best long term interests — and those of Asia as well? That's the kind of judgement Walter Lippman was talking about when he said that good foreign policy 'consists in bringing into balance, with a comfortable surplus of power in reserve, a nation's commitments and a nation's power.'
The alternative — the 'punt or persevere' way of seeing things — risks propelling America into a situation in which it does face a catastrophic and avoidable choice between a military clash with China or a humiliating back-down. That's the risk that current US policy runs right now in the South China Sea.
To read Kurt Campbell's reply to this review, click here.
As Assistant Secretary of State for Asia in Barack Obama's first term, Kurt Campbell has a respectable claim to being the principal architect of the president's Pivot to Asia. Not surprisingly, then, his new book The Pivot: The Future of American Statecraft in Asia argues that the Pivot is the right policy for America in Asia over coming years, and explains how it should be elaborated and extended under the next president.
Kurt's book will resonate with those who already think the Pivot has been good policy. The question is whether it can persuade the sceptics to change their minds. I'm not sure it will, because it fails to effectively address key weaknesses which were clear enough when the Pivot was first launched, and have become clearer still in the years since.
First, Washington has never clearly identified or analysed the problem which the Pivot is supposed to solve, and The Pivot doesn't either. And yet there is no mystery here. America's problem in Asia today is that China seeks to take its place as the primary power in Asia, and the shift in relative power between the two countries over recent decades makes China's challenge very formidable indeed. This simple fact must be at the centre of any serious analysis of America's policy options in Asia.
The Pivot mentions China a lot, but does not plainly acknowledge the centrality of its challenge to America's predicament in Asia today, and nowhere seriously assesses the power and ambition that drive China's challenge. Nor is the book clear about America's objectives. In places it says America's aims include preventing Asia falling under someone else's hegemony, but elsewhere that the Pivot is all about preserving Asia's geopolitical 'operating system', by which it plainly means preserving the status quo based on US primacy.
Thus the book, like the policy itself, is based on evasions about both China's and America's aims, and therefore avoids acknowledging how directly those aims conflict, and how stark and serious the resulting confrontation between them has already become.
From this first weakness flows a second. Because The Pivot does not clearly identify the scale of the problem, it does not offer solutions that measure up to it. Its policy proposals, set out in a 'Ten Point Plan', are not set against the scale of the task required of them, or the obstacles they face. The ten points include, for example: mobilising US public support for engagement with Asia (but without mentioning Donald Trump or Bernie Sanders); strengthening US alliances (but without mentioning the reluctance of US allies to be seen to align against China); and 'Setting the Contours for China's Rise' (but without acknowledging that China has no reason to accept America's 'contours' and plenty of ways to set some contours of its own).
Here too the weakness of the book reflects the weakness of the policy after which it is named. The practical steps taken under the Pivot have always been far too modest to meet the challenge America faces in Asia. Indeed, it is hard to imagine that they were ever intended to have more than a symbolic effect. The Pivot's architects apparently assumed that a merely symbolic reassertion of US power and resolve would be enough to make China back off and abandon its challenge. China's assertive posture in the East and South China Seas today is strong evidence that they were wrong. And yet this assumption infuses The Pivot.
Which brings us to the third weakness of the book, and of the policy. Neither seriously consider the costs to America of the measures that would be needed to achieve what they presume to be America's aims of resisting China's challenge and preserving US primacy. They underestimate the challenge, they underestimate the measures needed to meet it, and they therefore underestimate the costs and risks America must run to do so – diplomatically, economically and, above all, strategically.
In particular, The Pivot has nothing to say about the most important single question facing America in Asia today: is it willing to go to war with China to preserve US primacy? This question, more than anything else, will determine the shape of future Asian order and America's role in it. China's recent conduct strongly suggests that it will only abandon its challenge to American primacy if it is really convinced that the answer is 'yes'. But nothing Beijing has seen or heard from Washington in recent years has convinced it of that, which is why it has been acting so boldly. Unless that changes, the chances of facing down Beijing's challenge are very low.
That will not change until an American president is willing to stand up and explain to America's people why US primacy in Asia is so important to them that they should be willing to go to war with China to preserve it. The answer to that question must encompass the fact that China is a nuclear-armed power with the capacity to destroy US cities. This is an issue which The Pivot entirely avoids. I found no substantive reference to China's nuclear forces in the entire book, nor to extended nuclear deterrence as the foundation of America's key alliances, and hence to its position in Asia. No analysis that evades these hard questions can address the future of America's Asia strategy effectively.
So Kurt Campbell's new book reinforces the impression that important elements of America's foreign policy establishment still haven't begun either to take China's rise seriously or to consider the momentous choices America faces in response to it. Until that changes, America's response to China is unlikely to become much more effective than it has been for the five years since Barack Obama launched the Pivot in Canberra. And so it becomes more and more likely that American power in Asia will continue to dwindle.
To read Kurt Campbell's reply to this review, click here. Photo: Getty Images/Feng Li
Let's put Mr Turnbull's diplomacy last week into context. While he was in China, US Defense Secretary Ashton Carter was in the Philippines talking up America's commitment to support Manila militarily against Beijing. At the same time, a senior Chinese general toured Beijing's bases in the Spraltys.
Meanwhile, the Permanent Court of Arbitration's judgement in the Philippines case against China is only a few weeks way, and credible reports say that China is preparing to build a base on the Philippine-claimed Scarborough Shoals or declare an air-defence identification zone over the Spratlys.
This all suggests that things are heading for some kind of showdown over the next couple of months. It seems the Court will find against China. If they do, China will probably react with some further provocation. And if that happens, Washington faces an ever-starker choice between responding militarily or taking a big blow to its strategic credibility in Asia. And so, in Churchill's plangent phrase, 'The terrible "ifs" accumulate'.
We cannot know whether or not these 'if's' will lead to a war, but we do know that this is just how wars often start: not when both states want to fight, but when each assumes it can get what it wants without fighting because the other will back down. Such a war, if it happened, would pose the gravest threat to Australia's security and prosperity in generations. And if war is only avoided by America backing down — which is becoming increasingly likely — then we face an almost equally grave collapse of the US role in Asia on which all our strategic expectations and policies are based.
This should be clear to Mr Turnbull and his advisers. If it is not, what further warnings of impending conflict are they waiting for before they take the risk of US-China conflict seriously enough to try to do something to avert it?
Which brings us back to Mr Turnbull in China last week. He didn't go to China to talk about this danger. He wanted to talk trade and innovation, but a well-timed warning in the Chinese media (interesting in itself) ensured that the main focus of his visit was on the South China Sea question and what he would say about it.
And what did he say? It seems he told the Chinese that they should stop building bases and deploying forces in the South China Sea, and instead submit their claims to adjudication in accordance with the so called 'rules-based global order'. To do otherwise, he apparently said, was contrary to China's own interests.
And what precisely was this expected to achieve? Did Mr Turnbull really expect that his remarks would apply that last bit of pressure needed to persuade China to abandon its newly-built bases, withdraw its forces, repudiate the nine-dash line and submit its claims over contested features to arbitration? That seems a long shot, to put it mildly. After all, the argument he put to them is one they have heard many times before, and it is hardly a zinger.
In fact the claim that China's actions are counterproductive to its own aims is almost certainly false. It assumes that Beijing wants to make friends and uphold the 'rules based global order', whereas their aims are clearly to display their growing power and replace the current order with 'a new model of great power relations'. In terms of furthering these aims, their pushiness in the South China Sea is working just fine.
So turning up in Beijing simply to rehearse well-worn clichés about regional order was not serious diplomacy. The natural conclusion is that Mr Turnbull neither intended nor expected his talking points to make any actual difference to China's policy, or to the situation in the South China Sea. He was just going through the motions, while the risk of conflict grows.
That seems close to a dereliction of duty, when the stakes for Australia are so high. But he got away with it politically because no one expected him to do anything more. Commentators assessed his diplomacy on the South China Sea solely as a test of his diplomatic mettle: would he show strength by speaking his mind, or chicken out and soften his message? No one asked what real difference it would make whether he did or not.
This prompts a question: why do our leaders aim so low in foreign policy, and why do the rest of us not expect them to aim higher? Why do we accept that the only thing at stake in Beijing last week was Mr Turnbull's reputation as a person willing to speak his mind?
Perhaps the answer is that we have lost the habit of serious foreign policy. For a long time we have been one of those lucky counties for whom the world works well to keep them secure and prosperous. Such countries easily take their good fortune for granted, and start to see diplomacy as a ritual in which one simply expresses one's views, and points are awarded merely for doing so. They forget that diplomacy can sometimes be an earnest and even desperate struggle to avoid disaster. What we saw in Beijing was classic lucky-country diplomacy.
It is reasonable to ask what Mr Turnbull should have done instead. That's a big subject for another time, but the first steps must be to acknowledge the nature and scale of the problem. That is not something he could start to do in Beijing. First he has to talk seriously at home about the risks and the choices that Australia faces, and talk seriously to Washington about their approach to China.
He could have done so in his Lowy Lecture last month, if he'd said something like what I've suggested here. But he ducked it. Perhaps he thinks there will be another chance later. He shouldn't bet on that because events are moving fast.
Photo by Lintao Zhang/Getty Images
I'm usually cautious about extended metaphors, but Akira Igata's neat depiction of Japan and Australia as a young strategic couple on a first date is illuminating as well as charming. However I don't share his reassuring conclusion that there will be no harm done if the candle-lit dinner does not lead to a long-term commitment.
That is because what Australia and Japan would agree to share in Mr Igata's metaphor is not a dinner for two but a multi-decade program which is central to Australia's future military capability. If the first date doesn't go well the two people can walk away with no harm done. But if the strtageic relationship with Australia does not live up to Japan's expectations for decades to come, then the future of the submarine project is thrown into doubt.
This is the necessary corollary of Japan's reasons for wanting to be Australia's submarine partner in the first place. Japan is willing to share its submarine secrets with us because it hopes and expects Australia to be a close strategic partner — an ally — in the future. We can hardly expect them to keep sharing those secrets with us if their hopes and expectations are disappointed.
So, to push the metaphor a step further, Japan is offering us not just dinner but an engagement ring on our first date, and if we walk away from the relationship, they will want the ring back. And here the metaphor breaks down, because a successful submarine project depends not just one a one-off transfer of technology and skills, but on continual interaction and exchange – and hence on continued Japanese trust and goodwill for decades into the future.
So if we choose the Japanese option, Australia would be betting the future of our submarine capability on our future willingness and ability to meet Japan's expectations of a long-term close strategic alignment. And in the fluid power politics of Asia today, that is a bet we would be most unwise to make.
Photo courtesy of Flickr user ARTS_fox1fire.
...the idea of the future being different from the present is so repugnant to our conventional modes of thought and behavior that we, most of us, offer a great resistance to acting on it in practice.
— John Maynard Keynes, 1937
...the idea of the future being different from the present is so repugnant to our conventional modes of thought and behavior that we, most of us, offer a great resistance to acting on it in practice.
— John Maynard Keynes, 1937
This line, quoted as an epigraph to the US intelligence community's Global Trends 2030 report a few years ago, has something to offer our debates today about Australian strategic policy. That is because where one stands on today's big questions mostly depends on how far one accepts the idea that Asia's future strategic order might be different from the present and recent past.
For example, those who find the new Defence White Paper credible tend to expect that Australia's strategic environment over the next few decades will not differ much in essentials from what we have known over the past few decades. Those who see bigger changes looming are more likely to find it wanting.
Likewise, those who think it is a good idea to base our future submarine capability on a closer strategic alignment with Japan expect that the roles, policies and relationships of Australia, Japan and the US will be much the same decades from now as they are today.
Michael Heazle's response to my Fairfax article and Interpreter post on the Japanese bid helpfully makes this clear. He argues that such an alignment would pose to no risk to our interests 'unless Australian security thinking dramatically changes over the next 20 years'. He says there is no reason for that to happen, because our current posture has served us so well for the past 60 years. Why would we ever want to change that, he wonders?
The answer, of course, is that circumstances change, and that policies that have worked well for so long might not work in future.
Of course if things do not change — if America remains the preponderant power in Asia, Japan remains its close and dependent ally, and China decides it has no choice but to accept that — then it would make perfect sense for Australia's strategic posture to remain unchanged as well.
And the surer you are that this is how things will turn out, the stronger the strategic argument for reinforcing our old posture by choosing Japan as our submarine partner. But the less sure one is that nothing much will change, the more weight one should give to the possibility that both Australia's and Japan's policies might change quite radically. If that happens, our interests might not align closely, or at all, raising big risks to a submarine deal which assumes that everything will stay just as we like it.
One possibility is that America and Japan might align together against China, but with Australia deciding not to join them. Another is that the US-Japan alliance might fade, Japan might confront China and we might choose not to side with it. A third is that Japan, having lost US support, might decide not to support Australia should we confront China. If any of these seem too wildly implausible, then look again at the quote from Keynes.
The reality is we simply do not know how Asia's strategic system will evolve, what role Japan will play, what hard choices Australia will face, and how far those choices might take us from an alignment with Japan three or four decades from now. But there are clear signs that the reassuring certainties evoked by Michael Heazle are already passing. The Japan we see today is already very different from the Japan we have known for decades past, as Malcolm Cook's recent Interpreter post so neatly shows ('Mugabe in Tokyo: The Warping of Japanese Foreign Policy'). And the America we see today is not the America we used to know either.
Things are changing in Asia. It is time we recognise this, and act accordingly.
Photo by Koichi Kamoshida/Getty Images
Sam Rogeveen's post last week about the strategic aspects of Japan's submarine bid focused on exactly the right question: What does Japan want? This is much more important to the subs decision than the question many people seem to think matters most, which is what China wants us to do.
Some think China's presumed opposition to closer strategic relations between Japan and Australia is reason enough to kill Japan's bid. For many others, Beijing's objections are the best reason to accept it. Neither are right. While we can't and won't completely ignore what China thinks, there is no reason to allow Beijing a veto if we decide, on mature reflection, that Option J serves our best interests overall. But Beijing's objections – assuming they do seriously object, which is not beyond doubt – are no reason to do something which is against our interests just because we like the idea of defying China.
So what about Japan? There is no doubt it expects a submarine deal to lead to a much closer strategic relationship, but it is less clear what exactly the Japanese have in mind, and therefore whether it would be in our interests.
I have argued that Japan seems to expect something close to a full-blown alliance, directed against China, under which Japan would be assured of Australia's support, including military support, in a crisis. Sam quotes Brad Glosserman, who says Japan's expectations may not run this high because there seems to be no enthusiasm among Japanese to depart from its old strategic posture and build a coalition against China independent of the US.
Some thoughts on this. First, we should not presuppose that Japan would only seek an alliance with Australia if it decided to strike out independently of America. In fact, it seems quite likely that Japan would see an alliance with Australia as a real asset while Tokyo remains a US ally, in part because the Japanese hope it would bolster America's willingness to help Japan in a crisis if Australia was stepping up too.
Second, while I'm sure Brad Glosserman is right that most Japanese would prefer to keep relying on the US, they may find that is no longer possible. If America proves unwilling to bear the costs of confronting China, Japan would face an inescapable choice between building an independent role as a great power or accepting subordination to China's strategic leadership.
Perhaps, for the reasons Brad Glosserman suggests, Japan would opt for subordination. That would worry Australia if we chose a different path and our submarine capability depended on Japan's support.
But it's at least as likely that Japan would decide to resist Chinese primacy. In that situation Japan really would want all the allies it could find, and Australia would be high on the list. My hunch is that this is at least part of the thinking behind Japan's enthusiasm for closer defence relations with Australia today. Not only would it reinforce Japan's US alliance for as long as that lasts; it would also be a building block for an alternative Japanese posture if the US alliance fails.
Whether it would serve our interests to ally with Japan in such circumstances would depend on how both China and Japan were behaving at the time. Australia would want the maximum flexibility to make a choice that suited us best in the circumstances. Tying our submarine capability to Japanese expectations of Australian support would very sharply limit that flexibility.
The bottom line here is that the less our strategic circumstances change, the more sense a strategic alliance with Japan makes. But the more they change, the more likely it is that an alliance with Tokyo would not be in our interests, and the greater the risk to a submarine capability that relied on such an alliance. And these are of course exactly the circumstances in which our submarines would be most important to us. A subs deal with Japan would work best when we needed subs least, and worst when we needed them most.
So it's clear that we really do need to know whether Japan does expect an alliance with Australia as part of a subs deal. We should not need to speculate about this. Tokyo needs to explain very clearly what kind of closer strategic relationship it expects to flow from the submarine deal, and we in Australia then need to debate what that would mean for us. If the Japanese are seeking serious strategic commitment, they need to say so as plainly as possible. If they are not, then let them come out now and say that, as plainly as possible. The ball is in Tokyo's court, and we'd be mad to make a decision before we have heard from the Japanese one way or the other.
Photo courtesy of Flickr user Atsuhiko Takagi
Whether Prime Minister Malcolm Turnbull intended it or not, his new Defence White Paper has been widely interpreted as sending a clear message that Australia is willing to join our allies in using armed force if necessary to defend the 'rules based global order' from China's strategic ambitions in Asia. Moreover, most people apparently think that's a good message to send.
So it seems wise to ask whether this message is really true. Would we go to war with China over any of the issues which now loom as tests of the future order in Asia — in the Spratlys, or the Senkakus, or even Taiwan?
Most people who approve of the White Paper's message probably do so with complete confidence that the issue will never arise. They assume war won't happen because they are sure the Chinese would always back down rather than risk a clash. Maybe they are right. Confronted with US and allied resolve, Beijing might decide that even Taiwan was simply not worth the immense costs of conflict.
But we shouldn't bet on that, because the Chinese probably think the same about America and its allies. They think a war would be just as costly to us as to them, and they believe the issues at stake matter more to them than to us. So they are likely to assume that, whatever we say now, on the brink we would back off rather than fight. And the more confident they are of that, the less likely they are to back down. It has happened before: in an escalating crisis, both sides assume the other will step back, and so neither does before it's too late. This is exactly what happened in July 1914.
Remember, the stakes are high for both sides. This is a contest over the future of the Asian order, and we should not for a moment assume that China is any less committed to building a new order than we are to preserving the old one. Unless one side or the other abandons its core objective, the chances of a crisis in the Western Pacific escalating to the point that we face a decision about going to war is already quite high, and is growing steadily.
So we ought to think seriously about what war with China over one of these issues would actually look like.
It is easy to start a war expecting a quick fight and an easy win. But America and its allies do not have overwhelming military superiority, and nor does China. That means neither side would be likely to win decisively after a short, contained conflict.
Both sides would therefore soon face a new choice: to escalate and accept the much higher costs of a big and protected war, or give up. Again, it is easy to assume that China would back off first, but we can't bet on that. China has an immense capacity to both inflict and absorb damage, and we cannot expect it to be any less committed to victory than we would be.
So would we back off and accept defeat to avoid escalation, if China didn't? This choice carries grave consequences, because both sides have nuclear forces, and there is a real risk of an escalating conflict crossing the nuclear threshold. Of course no one can imagine it coming to that, but it could unless one side backed down. And how can we be sure the Chinese would back down if we wouldn't? Alternatively, if we were capable of backing down, wouldn't it be better never to have started the war in the first place?
Even without a nuclear exchange, this would soon become the biggest and most costly war since 1945, and the end of all we envisage for the Asian Century, even if we won. And what would 'winning' even mean? Neither side has any chance of a decisive victory, so it is hard to imagine how a war with China ends. That alone should give pause to those who think it might be a good idea to start one.
In fact, I think it is unlikely Australia would go to war with China in any situation short of the outright invasion of the undisputed territory of another sovereign state. I think it is quite unlikely America would either, once a president was brought face to face with the military realities. So we are just bluffing, and our bluff is being steadily and systematically called by China.
None of this is to deny that Australia, like others, has a huge stake in the way Asia's regional order evolves, and that we need to do whatever we can to prevent changes in the order that affect our truly vital interests. Moreover, it is not to deny that some principles of regional order would be worth going to war with China to defend.
But we do have to ask whether the costs and risks of such a war are justified to defend every element of the so-called 'rules based global order' in places like the South China Sea. More realistically, we will have to accept some changes in the regional order to accommodate China. We all find the idea of making such an accommodation uncomfortable, even scary. But is it scarier than war with China? It is time to think carefully about that. And it is time to stop talking tough when we don't mean it. It is undignified as well as dangerous.
Photo courtesy of Australian Defence Image Library.
The trickiest part of Malcolm Turnbull's speech in Washington today was always going to be the passage about China. This was the issue on which, to judge by what he said before becoming Prime Minister, Mr Turnbull's ideas are most at odds with Washington's and with his predecessors.
He has argued in the past that China's rise inevitably means big changes in Asia's strategic order, which clearly implies a bigger role for China and a lesser role for the US than we have been used to in recent decades. This is not something any Australian leader has been brave enough to say before, and it is not something anyone in Washington wants to hear. So perhaps we should not be surprised that he chose not to venture too directly into such territory on his very first visit to DC as Prime Minister.
Instead he quoted Thucydides, citing the famous line about war between Athens and Sparta being inevitable, and laying great emphasis on Xi Jinping's statement in Seattle last year, when Xi denied there was a 'Thucydides Trap' and predicted a peaceful trajectory for US-China relations.
All this attention on Thucydides owes a lot to Graham Allison, who in an influential essay in The Atlantic last September, argued that war had been avoided in four of 16 historical cases of a rising power confronting an established power. Not all of his four exceptions to Thucydides' rule are necessarily reassuring: he counts the US-Soviet rivalry of the Cold War, for example, among them. But the basic point is fair: the Thucydides trap can be avoided.
However the really important part of Allison's analysis comes at the end, where he explains what will be needed to avoid it. Here are his concluding paragraphs, which are worth quoting at length:
'At this point, the established script for discussion of policy challenges calls for a pivot to a new strategy (or at least slogan), with a short to-do list that promises peaceful and prosperous relations with China. Shoehorning this challenge into that template would demonstrate only one thing: a failure to understand the central point I'm trying to make. What strategists need most at the moment is not a new strategy, but a long pause for reflection. If the tectonic shift caused by China's rise poses a challenge of genuinely Thucydidean proportions, declarations about "rebalancing," or revitalizing "engage and hedge," or presidential hopefuls' calls for more "muscular" or "robust" variants of the same, amount to little more than aspirin treating cancer. Future historians will compare such assertions to the reveries of British, German, and Russian leaders as they sleepwalked into 1914.
The rise of a 5,000-year-old civilization with 1.3 billion people is not a problem to be fixed. It is a condition—a chronic condition that will have to be managed over a generation. Success will require not just a new slogan, more frequent summits of presidents, and additional meetings of departmental working groups. Managing this relationship without war will demand sustained attention, week by week, at the highest level in both countries. It will entail a depth of mutual understanding not seen since the Henry Kissinger-Zhou Enlai conversations in the 1970s. Most significantly, it will mean more radical changes in attitudes and actions, by leaders and publics alike, than anyone has yet imagined.'
'At this point, the established script for discussion of policy challenges calls for a pivot to a new strategy (or at least slogan), with a short to-do list that promises peaceful and prosperous relations with China. Shoehorning this challenge into that template would demonstrate only one thing: a failure to understand the central point I'm trying to make. What strategists need most at the moment is not a new strategy, but a long pause for reflection. If the tectonic shift caused by China's rise poses a challenge of genuinely Thucydidean proportions, declarations about "rebalancing," or revitalizing "engage and hedge," or presidential hopefuls' calls for more "muscular" or "robust" variants of the same, amount to little more than aspirin treating cancer. Future historians will compare such assertions to the reveries of British, German, and Russian leaders as they sleepwalked into 1914.
The rise of a 5,000-year-old civilization with 1.3 billion people is not a problem to be fixed. It is a condition—a chronic condition that will have to be managed over a generation. Success will require not just a new slogan, more frequent summits of presidents, and additional meetings of departmental working groups. Managing this relationship without war will demand sustained attention, week by week, at the highest level in both countries. It will entail a depth of mutual understanding not seen since the Henry Kissinger-Zhou Enlai conversations in the 1970s. Most significantly, it will mean more radical changes in attitudes and actions, by leaders and publics alike, than anyone has yet imagined.'
From everything Mr Turnbull wrote and said about the issue before he became Prime Minister, one would have judged that he agrees with every word that Allison writes here. But that is very far from the impression one would get from what he said in Washington today. There he only spoke of what China has to do to avoid the Thucydides Trap:
Now, if avoiding the Thucydides Trap is a core objective of China's strategy - as President Xi insists it is - then we would hope that China's actions would be carefully calculated to make conflict less likely, not more, and would seek to reassure neighbours of and build their confidence in China's intentions.
Now, if avoiding the Thucydides Trap is a core objective of China's strategy - as President Xi insists it is - then we would hope that China's actions would be carefully calculated to make conflict less likely, not more, and would seek to reassure neighbours of and build their confidence in China's intentions.
Of course this is half right: if escalating rivalry and conflict are to be avoided, then China will have to be willing to moderate its ambitions and calibrate its actions. This is a message that needs to be delivered loud and clear in Beijing. But it is only half the story, and it is not the half that needs to be heard in Washington.
Whatever we might wish, escalating rivalry in Asia will not be avoided if we wait for China to make all the concessions. America too is going to have to rethink its role in Asia and its relationship with China – these are 'the radical changes in attitudes and actions' that Allison is urging.
This is a message that Washington still doesn't get and badly needs to hear, and not just from scholars like Allison. It needs to hear it from leaders like Turnbull. He missed the opportunity this time. Maybe next time.
Photo courtesy of Flickr user CSIS | Center for Strategic & International Studies.
Those lucky enough to have worked with Ken Ward over his many years of government service will smile as they read his fine Lowy Paper on Australia's relations with Indonesia. It has just the same droll and occasionally mordant tone that characterised his work in DFAT and elsewhere, as well as his precise eye for detail and talent for exposition. It is no surprise, then, that Condemned to Crisis is one of the best things written for many years about the contemporary management of this relationship, and a model of plain and forthright exposition. I strongly recommend it.
Ken's central message is simple enough. He thinks that crises in the relationship are inevitable, but that governments can manage them better by understanding Indonesia's perceptions and sensitivities better and by not allowing the media or opposition to set the terms of discussion. Meanwhile, we should not be too ambitious about the relationship: it serves our interests well enough as it is, and we should not expect it to get much better or exaggerate how much it matters if it doesn't.
All of this is sound, sober and wise, based as it is on Ken's experience observing the relationship over several decades. As a guide to managing issues with Jakarta day-to-day, or even year-to year, it could hardly be bettered. Indeed if the routine management of the status quo was all that our foreign policy needed to do, there would be very little left to say. Ken has pinned it with a lepidopterist's precision.
But is that all our foreign policy needs to do?
Running relationships day-to-day on the basis of past experience will get us a long way, but it will not help us adapt to big changes when they happen – as they sometimes do. So we also have to look to the future and ask what big changes might be looming, and what we can do to manage them.
One gets the impression that Ken is a little impatient with speculation about the future. If so, this is something he shares with many Australian foreign-policy professionals. Indeed, one might say that the professional ethos of our foreign service today emphasises a briskly practical, no-nonsense approach to the management of today's immediate problems and issues. It tends to disparage reflection about the future and how our policy might prepare for it, and shape it to our advantage.
But if we do not speculate about the future – even the relatively distant future of two or three decades ahead – then we miss opportunities to adapt to it, and risk finding ourselves stuck with old policies that do not work anymore.
This risk looms large in relation to Indonesia, because the circumstances of the relationship are changing in two important ways.
The first is the big shift in economic relativities, a shift which has already occurred and seem likely to continue over coming decades, which makes it likely that Indonesia will end up with a much bigger economy than ours. Hence, in a very important way, Indonesia will be more powerful. Ken touches on this, but does not reflect on what it might mean for the relationship.
The second is the bigger shift in the regional order that is being driven by the wider shift in the distribution of wealth and power in Asia. This is important to Ken's theme because the Australia–Indonesia relationship does not exist in a vacuum. It is profoundly influenced by the wider regional environment in which both countries live.
It has been easy to overlook this, because the regional order has been so stable for so long — until recently. But if, as seems likely, Asia works rather differently over coming decades from the way it has worked over the period covered by Ken's analysis, then it seems likely that the Australia-Indonesia relationship will work differently too.
These thoughts might nudge us towards some conclusions a little different from Ken's. In particular it might lead us to ask whether the relationship with Indonesia will become more important to us in future than it has been in the past, presenting both bigger risks and bigger opportunities.
If so, then perhaps we should not be as content as Ken appears to be with a relationship which is somewhat better managed but not essentially different from the troubled one we know today. In turn, that suggests Australian policymakers should put higher priority on changing the basics of the relationship rather than just managing it.
Of course that is a rather ambitious objective, especially compared to the modest way we have conceived foreign policy in Australian recent years. But worth a try, surely?
Photo courtesy of DFAT.
It seems likely that President Obama's flagship Asian free-trade deal, the Trans Pacific Partnership (TPP), will sink in the US Congress. Those who worry about its implications in specific sectors like pharmaceuticals might think this is a good thing. But what would be the broader implications? That depends on what difference TPP would make if it floats. The answer comes in two parts.
On the economic side, the answer is probably 'not much' overall. The TPP would not work like a classic free trade agreement, boosting trade by lowering protection, because as Lawrence Summers pointed out the other day, protection is now so low that there is not much to be gained by lowering it further.
Perhaps the trade-promotion effects would be bigger for some more protected economies like Vietnam, but even here some elements of the TPP might have the opposite consequences. To many Americans, the best parts of the TPP are those setting new environmental and labour standards that countries like Vietnam would find hard to meet.
The TPP is also intended to boost investment, yet here too the long-term impact on economic growth seems likely to be small. So, like other FTAs, the overall economic impact of the TPP will be modest at best.
But as everyone knows, the TPP is not really about economics, at least for the Obama Administration. Since 2011 the TPP has been seen, and sold, primarily as an element of the Administration's 'pivot' to Asia. The idea is that the TPP will help protect US political and strategic primacy in Asia by restoring the regional economic leadership which America had enjoyed for so long, and which China has been so successfully taking over in recent years.
Washington is right to think this matters. The more important China becomes to its Asian neighbours economically, the harder it will be for America to persuade them to reject Beijing's claims for a 'new model of great power relations' in Asia, and the further US leadership will erode. Anyone listening to Tony Abbott's fulsome remarks about President Xi Jinping this week at the signing of the new China-Australia FTA will understand America's problem.
But it seems a fantasy to imagine that the TPP can solve this problem. That would require a fundamental restructuring of the Asian regional economy. The TPP would have to displace China from the central position which it has built over the last two decades, and create a new regional economic order re-centred on America.
That means counteracting the immense gravitational pull of China's economy. To see how hard that would be, just look at Australia's trade. These days we export more than six times as much to China as we do to America ($108 billion vs $17 billion). Of course, trade isn't everything – the investment numbers still go America's way – but the trends are clear and the TPP has no chance of offsetting them.
Even at relatively sluggish levels of growth, China's economy will remain a much richer source of new economic opportunities for the rest of Asia than America has any hope of being, with or without the TPP. It would make at most a marginal difference to America's relative economic weight in Asia. It would make no difference to the essential reality that China is far more important to Asia's economic future.
And that means that even if the TPP floats, the countries of Asia will remain cautious about risking their economic prospects with China in order to preserve American regional primacy. It would do very little to help America resist China's challenge to US primacy in Asia.
But that doesn't mean America's debate over the TPP makes no difference to its future standing in Asia. On the contrary, it might make quite a big difference, because the Obama Administration has itself made TPP a test of US resolve in Asia. So while a successful TPP campaign would do little if anything to solve Washington's strategic problems in Asia, a failed campaign would make those problems worse.
What we might call 'the balance of resolve' is central to the contest between America and China for leadership in Asia today, and it already leans China's way. As they become more evenly matched in other forms of power, China's most important asset in that contest is the perception — in China itself, in the region and in America — that it is more committed to overturning Asia's US-led status quo than America is to preserving it.
That perception will grow stronger if Congress wrecks the TPP, pushing the balance of resolve further in China's favour, and further weakening US leadership in Asia. If that happens Obama himself will be in large measure to blame, because he is the one who has turned the TPP into a test which will not help America if it is passed, but will hurt it badly if it is failed.
Deterrence is a beguiling concept. It offers the hope that we can prevail over our opponents without actually fighting them because our mere possession of military power will be sufficient to compel them to our will.
This seductive idea seems to be the basis of Michael Cole's view that deterrence will allow America and its allies to defend Taiwan from China with incurring the costs and risks of conflict, and that they should therefore commit themselves to doing so. This view is set out in Michael's most recent contribution to an exchange between us about this issue, and I'd like to thank him for his thoughtful part in our exchange on this sensitive topic.
Alas, I think this view of deterrence is mistaken. Deterrence can work, of course, but only where the deterred power believes that the deterring power is willing to incur the costs and risks of conflict. So Washington can only deter Beijing from using force against Taiwan if Beijing is reasonably sure that Washington is willing to actually fight to do so.
Moreover, because the stakes are so high and the nuclear threshold is so unclear, Washington must convince Beijing that it is willing to fight a nuclear war over Taiwan if it is to deter China from starting a conventional one. Simply possessing armed forces, including nuclear forces, is not enough to do this. You also have to convince the other side that you are willing to use them, and are willing to incur the costs and risks of the resulting conflict.
There is, as Michael acknowledges, a parallel here with the Ukraine. Many in the West believed Russia could be deterred from any military intervention in the Ukraine. But deterrence did not work because Moscow did not believe that Washington cared enough about Ukraine to accept the costs and risks of a military conflict with Russia.
Some might hope that China can be convinced that the US is willing to fight, even if it isn't. This is called bluffing, and it's a dangerous and unreliable tactic. And this is precisely why America cannot reliably deter China from attacking Taiwan. As Michael himself acknowledges, there are real doubts that America would be willing to go to war with China. It seems likely that those doubts are shared in Beijing, and they cannot be dispelled simply by rhetorical reaffirmations of the Taiwan Relations Act, because they arise from a quite reasonable assessment of the balance between costs to America of reunification on the one hand, and the costs of war with China on the other.
This assessment does not minimise the costs of unification, both to America and to the Taiwanese themselves. It simply sets them realistically against the costs and risks of war with China, which Michael seems to agree are exceptionally grave. And if Americans are not convinced of US resolve, why should we expect China's leaders to be? And if they are not reasonably sure that the US would be willing to actually commit its formidable forces to fight for Taiwan, how can they deter China from attacking it?
The conclusion seems clear: America cannot defend Taiwan unless it is really willing to fight China to do so, and unless it is plainly willing to do that, Washington should not mislead the Taiwanese into thinking that they can rely on American support if the worst happens.
Photo by Flickr user See-ming Lee.
After a decade of relative harmony, tensions between Beijing and Taipei are rising again. As Taiwan's leaders and voters face big choices about their future relations with China, America must think carefully about its commitments to Taiwan.
Would America be willing go to war with China to prevent Taiwan being forcibly united with the mainland? J Michael Cole, responding in The National Interest to a recent op-ed of mine in Singapore's Straits Times, expresses a widely held assumption that it would, and should.
To many people it seems self-evident that America would honour the commitments enshrined in the Taiwan Relations Act. But the TRA was passed in 1979, when China's GDP was 1/20th the size of America's, its place in the global economy was miniscule, its navy and air force were negligible, and its prospects for progress depended completely on America's goodwill.
So back then a US-China conflict carried much bigger economic and military risks for China than for America. That made the TRA's commitments both highly credible and very unlikely to be tested. Washington could safely assume that Beijing would back off to avoid a conflict in which China had so much more to lose than America.
Things are different today.
China's economy is now so big and so central to global trade and capital flows that the consequences of any disruption would be just as serious for America as for China. Militarily, America can no longer expect a swift and certain victory in a war over Taiwan. China's anti-access/area-denial capabilities would preclude direct US intervention unless those capabilities had first been degraded by a sustained and wide-ranging strike campaign against Chinese bases and forces.
China would very likely respond to such a campaign with attacks on US and allied bases throughout Asia. The US has no evident means to cap the resulting escalation spiral, and no one could be sure it would stop below the nuclear threshold. The possibility of nuclear attacks on US cities would have to be considered.
These new realities of power mean that today a US-China conflict would impose equal risks and costs on both sides. And where costs and risks are equal, the advantage lies with those who have more at stake, and hence greater resolve. China's leaders today seem to think they hold this advantage, and they are probably right. It is therefore a big mistake to keep assuming, as many people seem to do, that China would be sure to back off before a crisis over Taiwan became a conflict.
US leaders must therefore ask what happens if Beijing does not back down as a crisis escalates. At what point would they back down instead? What would be the damage to US global leadership if Washington brought on a confrontation with China and then blinked first? What could happen if Washington didn't blink first? Is Taiwan's status quo worth a global economic collapse? It is worth a real risk of nuclear war with China?
These are the questions America's leaders would have to confront in considering military action to defend Taiwan, and their answer would very likely be that the status of Taiwan is not worth risking nuclear war or economic collapse over. And that means American leaders and policy analysts must confront these questions now, as they decide whether to maintain the old commitments to defend Taiwan. The promises that America was willing and able to keep in 1979 might not be ones it is willing or able to keep now.
What about America's allies and friends in Asia? Wouldn't they help America defend Taiwan, if only because they are so worried themselves about China? Many Americans seem to assume they would. But even Australia, America's most reliable ally in Asia, is uncertain about this. And if Australia is uncertain, it is pure wishful thinking to expect the likes of India, Singapore, Vietnam or even the Philippines to offer anything more than mild diplomatic support to America over Taiwan.
The exception is Japan, which under Shinzo Abe might be expected to join the fight, especially after last week's visit to Washington. But does Mr Abe really speak for Japan? Will future Japanese leaders take the same view? And even if they did, how exactly would that help America? How would Japan's support change the answers to the hard questions posed above, and increase the chances that America would indeed come to Taiwan's aid?
So no one should lightly assert that America or its allies would help defend Taiwan from China. But should they? This is a big subject. Suffice to say here that the question is not answered simply by using the word 'appeasement' to invoke the memory of Munich.
There are hard questions to be answered about how far we should be willing to go to accommodate (or, if you prefer, to appease) China's ambitions for a bigger regional leadership role as its power grows. Any substantial accommodation would mean a shift away from the US-led order of recent decades, which would be risky and unsettling. It seems much easier to evade these questions by refusing to contemplate any accommodation at all. But that would carry high costs.
Those who assume that those costs must be worth paying might not have thought carefully enough about just how high the price could go. And those who assume that it will be impossible to accommodate China because it proved impossible to appease Hitler perhaps assume that there are no material differences between the situations in Europe in 1938 and in Asia now, or between Nazi Germany and today's China. They perhaps also assume that there are no alternatives to the old US-led order in Asia except Chinese hegemony. The magnitude of the issues at stake – including for the people of Taiwan – suggest that these assumptions need more careful scrutiny.
For a long time American (and Australian) thinking about China has been dominated by a broad consensus that, despite many signs of growing assertiveness, Beijing does not pose a fundamental challenge to US leadership in Asia. The argument goes that, whatever they might say, China's leaders know that its economic future is too uncertain, its political system too fragile, its military too weak and its friends too few to allow it to contest American primacy. They also know that China's own stability and prosperity depend on the regional order that only America can uphold.
Therefore, the consensus has concluded, America doesn't have to do much in response except remind everyone that it intends to stick around. Hence the 'pivot', which has emphasised declaratory statements rather than substantive actions.
But that consensus may be unravelling, at least in America. Washington's AIIB debacle seems to have sounded a wake-up call and now, in just the past week, two major reports from the heart of the US foreign policy establishment have chimed in too. Both reports argue that China's challenge to US primacy in Asia is for real, and that America's policy in Asia needs to shift radically to respond.
At first glance they offer diametrically opposed views of what that response should be, in ways that might appear to frame the debate Washington is now having about how to respond to Beijing's challenge.
In fact, as we shall see, they share a reluctance to address the real issue, and to acknowledge the real risks.
One of these reports is by our own Kevin Rudd (US-China 21: The Future of US-China Relations Under Xi Jinping). It is the product of his stint at Harvard's Belfer Centre, and is now being showcased by his new home at the Asia Society. The other, from the Council on Foreign Relations, is by two well-known policy heavyweights, Robert Blackwill and Ashley Tellis (Revising US Grand Strategy Toward China).
Both reports argue that China's economic rise marks a fundamental shift in the distribution of power in Asia, and that China's leaders, especially under Xi Jinping, are determined to use their newfound strength to transform the Asian order in their favour. Rudd's argument on this is particularly strong, in part because he draws on a deeper understanding of China. It reminds us that, at his best, Rudd can be a very good analyst indeed.
So what should America do? Rudd says America and China can resolve the tensions caused by China's ambitions through diplomacy. The two powers can and should negotiate in a spirit of 'constructive realism', deepening cooperation where their interests coincide while quarantining and managing the issues on which they disagree.
It's a nice idea, but Rudd's account of it evades the hard question: is America willing to deal with China in the way he proposes? His model implies a complete transformation in the nature of US-China relations so that they become true partners in regional leadership. But his prescription will only work if America is willing to deal with China as an equal, which is of course incompatible with the old model of US regional leadership in Asia.
Yet Rudd does not acknowledge this in his report. No doubt he understands that it is something his American audience will not want to hear, but until this issue is squarely addressed, America's debate about China will keep on missing the mark.
Blackwill and Tellis do not make this mistake. They say upfront that perpetuating US primacy is America's primary strategic objective, and they urge America to build up its economic, military and diplomatic position in Asia to preserve it from China's challenge. This is, in effect, a policy of containment. Any accommodation of China's ambitions is ruled out.
They are rather glibly optimistic about what this policy would require. They call for the strengthening of America's economy, military power and diplomacy to counter China's rise, and a 'geo-economic' counter-offensive against China's growing economic sphere of influence, without saying how all this might be done. This suggests they do not really understand how radically China's rise has shifted the distribution of power.
But more importantly, Blackwill and Tellis are optimistic about how China would respond. They say America could continue cooperating with China where that suits US interests, while relentlessly resisting China's ambitions to build a new regional order. Their policy prescription assumes that China will be happy to continue working with the US on these terms. In other words, their prescriptions assume what their analysis disproves: that China is not really serious about challenging US primacy after all. If that was true, America could follow Blackwill and Tellis' prescription to resist China's challenge and preserve its primacy without running the risk of disrupting its relationship with China, which is what Americans want to hear.
This brings us to point where Blackwill and Tellis converge with Rudd. Both reports evade the fact that strategic rivalry between America and China is ultimately caused by their fundamentally incompatible aims in Asia. America's primary aim is to retain leadership in Asia, and China's is to displace it.
Rudd assumes America will abandon its aim, while Blackwill and Tellis assume it will be China that steps back. Rudd at least assumes that China will also be willing to compromise, whereas Blackwill and Tellis seem to think that America need make no substantial concessions to enjoy a peaceful relationship with China.
The big risk, of course, is that neither side will be willing to make concessions, because each expects the other to blink first. That leads straight to escalating rivalry and an ever-higher risk of war. Both these reports downplay that risk, because they seem to assume China does not want to change the regional order enough to risk a military confrontation with the US.
Photo courtesy of Flickr user U.S. Department of Defense.
Jim Molan is dismayed by my suggestion that strategic-level policy is not the ADF's strong suit. The offending line — in an article by Sophie Morris in last week's Saturday Paper — accurately reflects my remarks to her. Jim's robust response peppers a rather larger target, however.
Among other things, he attributes to me the view that Defence civilians are much better at strategy than their uniformed colleagues. So to be clear, I do not believe that civilians are any better at providing strategic policy advice than military officers. On the contrary, had I been asked, I would have said that the depth and breadth of strategic policy expertise among civilians in the Defence Department is just as inadequate as it is among their military colleagues. This is a major problem for our defence policy which, to be fair, I believe the senior leadership of the organisation understands.
My primary point to Sophie was simply that serving in the ADF, perhaps at quite a junior level, does not in itself guarantee that a parliamentarian will have special expertise in the defence and strategic policy decisions discussed and made at the political level.
But the broader point remains true too: the ADF as an institution does not generally (with some notable exceptions) excel at the strategic-level tasks of advising governments about when and how they should use force to achieve policy objectives, and about what capabilities Australia needs.
I would offer as evidence the flawed advice that led to Australia's costly strategic failure in Afghanistan (and yes, I have no doubt that it was a failure), and the advice to acquire the amphibious assault ships (pictured), which I believe are now becoming widely recognised as the white elephants they are. I think the ADF's strategic-level advisers, along with their civilian counterparts, must take some share of the responsibility for these decisions, if indeed they spoke in favour of them or failed to speak to robustly against them.
Photo by Flickr user Crouchy69.
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The Lowy Institute for International Policy


text:
Urgent care centers in the United States provide an increasingly important option between a physician's office and a hospital emergency room. They provide walk-in, extended hour access for acute illness and injury care that is either beyond the scope or availability of the typical primary care practice. With a need to reduce emergency room visits and the influx of patients expected due to healthcare reform legislation, urgent care could play a decisive role in healthcare in the near future.
This report, The U.S. Market for Urgent Care Centers, represents Kalorama's analysis of the current market and future opportunity for urgent care centers. The report looks at center location growth, and the market for services performed by urgent care centers.
The report also looks at sales that suppliers may earn selling products to urgent care centers including the following:
The urgent care business model involves providing a full range of services of non-emergency acute care. The model promises service and relies on a substantial investment in equipment and staff. Most have a physician on staff, generally more than one. UCC's differ from traditional Physicians' offices with procedure rooms for lacerations and fractures, radiology department for x-ray services, and a laboratory. While some traditional physician practices may have these facilitates, it is more the exception. Convenient hours are a key strength of urgent care centers. Most urgent cares have hours at least as early as 8 a.m. but sometimes 7 a.m. and close at 8-10 p.m. at night.
In addition to market estimates and forecasts, the report provides the following:
This report describes the Information for this report was gathered from a wide variety of published sources including company reports, catalogs, materials and public filings; government documents; trade journals; newspapers and business press; analysts' reports and other sources. Surveys of urgent care centers that have been published in journals and government websites were an important part of visit and revenue analysis. Specific business plans and revenues of individual operators and chains in different areas of the United States were examined to determine trends.
Table of Contents
Chapter One: Executive Summary Growth in Urgent Care Centers Drivers Limiters The Need For Urgent Care Urgent Care Center Market Opportunity For Suppliers – Imaging, IVD, Pharmaceutical Scope and Methodology Conclusions
Chapter Two: Introduction The Costly and Overcrowded ER ER costs vs. Urgent Care Costs Urgent Care Clinic Business Model Investment Ownership Services Payment Sources for UCCs Age of Centers Urgent Care Hours
Chapter Three: Issues and Trends Healthcare Reform: Patient Swoon? Components of Healthcare Reform High Risk Pools Dependents Medicaid Health Care Exchanges Doctor Waiting Room Times Mixed Use Centers Out of Pocket Expenditures 3 Year Medical School EMTALA Relieving ERs and Referring to Hospitals EMR Usage at Urgent Care Centers "Prudent Layperson" Standard Physician Shortage Hospital Competitive Moves Vs. Urgent Care
Chapter Four: Market Analysis Center Growth Forecast Urgent Clinic Sales Forecasts Urgent Care Sales by Type of Visit Imaging Equipment Sales to Urgent Care Centers Diagnostics Test Sales to Urgent Care Centers Clinical Chemistry CBC Testing Pregnancy Ovulation Urinalysis Microbiology Culture Diabetes HIV POC Testing Influenza Prescriptions Written at Urgent Care Centers Vaccinations at Urgent Care Centers
Chapter Five: Company Profiles Concentra MedExpress Urgent Care Doctors Express Dignity Healthcare Doctors Care NextCare FastMed Carespot Patient First Aurora Urgent Care Intermountain InstaCare Carolinas HealthCare MD NOW
List of Exhibits
Chapter one: Executive SummaryFigure 1-1: Number of Urgent Care Centers, 2008-2016 Figure 1-2: Growth in Urgent Care Centers and Decline in ERs, 2008-2012 Figure 1-3: Revenue at Urgent Care Centers by Service
Chapter Two: IntroductionFigure 2-1: Millions of ED Visits in the US 2009-20912 Figure 2-2: Average Cost of Visits, ER vs. Urgent Care Table 2-1: Type of Staff Employed Figure 2-3: Ownership of Urgent Care Centers (Hospital, Physician, Corporation, Non-Physician Individual) Figure 2-4: Urgent Care Payment Source (Insurance, Medicare/Medicaid, Other) Figure 2-5: Age of Centers (5 Years or More, Under 5 Years) Figure 2-6: Opening Hours, Average Weekday Figure 2-7: Closing Hours, Average Weekday
Chapter Three: Issues and TrendsTable 3-1: Example of Three Year Medical College ProgramTable 3-2: Use of Health Information Technology, NIH study
Chapter Four: Market AnalysisTable 4-1: The U.S. Market for Urgent Care Services, 2010–2017 Table 4-2: Urgent Care Market by Procedure (Infection, Anxiety/Mental Disorder, Respiratory, Stomach, Skin, Fracture, Lacerations/Wounds, Cold/Flu, Lab, Pharmacy, X-Ray/Imaging, Vaccine, Membership Fee, Aesthetic, Physical, Other) Table 4-3: Imaging Sales to Urgent Care Centers (X-Ray, Ultrasound, CT) Figure 4-1: CLIA Status of Urgent Care Centers (No Diagnostics, CLIA-Waived only, Moderate Complex CLIA, Full Certification) Table 4-4: Diagnostic Sales to Urgent Care Centers, 2012 and 2017 (Chemistry Panels, Complete Blood Count, Cholesterol/Lipids, Diabetes, TSH, Strep, HIV, Pregnancy, Flu, Urinalysis, Drugs of Abuse, Cardiac Markers, Culture, Others)Figure 4-2: Test Revenues At Urgent Care Centers Table 4-4: Prescriptions Written at Urgent Care Centers by Type (Antibiotic, Flu, Painkiller, Asthma, Pres. Cough, Steroid, Others) Table 4-5: Commonly Prescribed Pharmaceuticals in Urgent Care Centers Table 4-6: Vaccinations Given At Urgent Care Clinics, millions (Flu, Child Immunizations, Tetanus, Hep)
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The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted LivingThe advancing age of the population makes long-term care an important consideration for health marketers. This report, The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living, covers the most important segments of th... Global Database of Home CentersThis company database includes the details of more than 3200 home centers in the world. The database contains the following information about the companies: Company nameContact detailsContact personsFinancial informationNumber of employees Th Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living Kalorama Information publishes its third edition of this detailed report on the long term care industry at a time of growth but also change and concern for the long term care industry. The economy has challenged the business strategies of ...
The advancing age of the population makes long-term care an important consideration for health marketers. This report, The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living, covers the most important segments of th...
This company database includes the details of more than 3200 home centers in the world. The database contains the following information about the companies: Company nameContact detailsContact personsFinancial informationNumber of employees Th
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subset: commoncrawl


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29 years of experience
North Richland Hills, TX 76180 Phone number & directions
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Patrick Barr:
View the full profile to get information on:
- Qualifications
- What's important to you
View full profile
Patient Reviews
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Prepare before visiting Dr. Barr
Prostate Cancer Patient Education Learn all about symptoms, treatments and medications by reading Vitals' prostate cancer patient education guide.Before Visiting Dr. Barr Learn More
|More Patient Guides & Topics
Specialties & Research
Dr. Patrick Barr, MD is board certified in Nuclear Medicine.
Education & Awards
Dr. Barr graduated from The University of Texas at San Antonio.
Dr. Barr has 13 hospital affiliations:
- Texas Health Harris Methodist Hospital Southwest Fort Worth
- Texas Health Presbyterian Hospital Of Dallas
Similar doctors nearby
Dr. Sam Nassar
Dr. Balaji Veerappan
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Dr. Myron Jones
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Dr. Rodney Bowman
- Additional Information
- Dr. Patrick W Barr MD is a male Nuclear Medicine Specialist, has 29 years of experience and practices in Nuclear Medicine.
- Where does Dr. Patrick W. Barr practice?
- Dr. Patrick Barr has 1 office location.
Dr. Patrick Barr practices Nuclear Medicine near North Richland Hills, TX.
See North Richland Hills Nuclear Medicine Physicians.


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Nick Skradski, Furbank, MO.
Nick Skradski, Furbank, MO.
Jamilah, NJ
MochaJuden, Philadelphia, PA.
Ronald Killebrew, Memphis, TN. If God made be black, he must had a good enough reason to do so, and that is good enough for me. Real talk.
Debra Farmer, East Lansing, MI.
Erin Raleigh, NC I cannot remember where I got this information from it's either from visiting "RACE: Are We So Different?" that opened at the National Museum of Natural Science in 2011 or/and Wiki on history of race I researched shortly after my visit to the museum. I learned how in Europe, the nobles needed […]
Doris Engelhart Rochester MN
Two Time Oscar Winning Sound Mixer Russell Williams II Reflects on Hollywood's Crisis of invisibility As Hollywood struggles with its crisis of inclusion and invisibility, we sat down with two-time Academy Award Winning Sound mixer Russell Williams II to talk about the challenge of diversity in front of and behind the camera in the entertainment […]
Former Attorney General Eric Holder on how his career has been shaped by Dr King. Every January, WYNC commemorates the legacy of Martin Luther King, Jr. with a special event at the Apollo theatre in Harlem featuring newsmakers, community leaders and artists who explore the life and legacy of the civil rights leader. As part […]


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Guinness Oyster Festival
Mullaney's Harp and Fiddle welcomes you to the Annual GUINNESS OYSTER FESTIVAL. Our special menu for the day features fresh oysters on the half shell, our famous fried Oysters, Oysters on the half shell, Oyster Poboys, Oyster Stew, peel and eat shrimp plus much more. We will also have a few of our fine regular menu items for order as well! Join us from Noon - 2AM. This is an event you don't want to miss!
Live Music Schedule:
Johnny Gallagher: 1:00PM - 3:00PM
The Skipper Johnson Band: 3:15PM - 5:45PM
Tim and John: 6:00PM - 8:00PM
Donny Irish: 9:00PM - 1:00 AM


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THE FLYERS' Silver Linings Playbook is running out of pages.
It is only the second full week of the season, but the Flyers' players fully recognize that moral victories don't count in the win column. And the pressure is only mounting, since the Flyers do not play for an entire week after tonight's matchup with the Penguins.
A 1-7-0 record and a full week of soul-searching for the front office could make for an uneasy few days off.


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SET 1: Olivia's Pool, Dogs Stole Things, Taste, Billy Breathes, AC/DC Bag, The Old Home Place, Theme From the Bottom, Wading in the Velvet Sea, Saw It Again, Limb By Limb, My Soul
SET 2: Down with Disease -> Piper -> Down with Disease -> Meatstick[1] -> McGrupp and the Watchful Hosemasters > Makisupa Policeman[2], Cecilia[3] > Hold Your Head Up > Rock A William, Run Like an Antelope[4]
ENCORE: Guyute
Add a Review
Mike Gordon: September 23, 2016
5 days ago
Catskill Chill at New Minglewood
Set 1: Say Something, Jumping, Waking Up Dead[1], Andelmans' Yard, Horizon Line, How Do I Know > Looking for Clues, Don't Chin The Dog, Let's Go[1], Tiny Little World
Encore: Yarmouth Road
[1] Mike Gordon debut.
Phish.net is a non-commercial project run by Phish fans and for Phish fans under the auspices of the all-volunteer, non-profit Mockingbird Foundation.
This project serves to compile, preserve, and protect encyclopedic information about Phish and their music.
Credits | Terms Of Use | Legal
The Mockingbird Foundation is a non-profit organization founded by Phish fans in 1996 to generate charitable proceeds from the Phish community.
And since we're entirely volunteer – with no office, salaries, or paid staff – administrative costs are less than 2% of revenues! So far, we've distributed over $750,000 to support music education for children – 210 grants in 43 states, with more on the way.


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Dan Hawkins doesn't care for depth charts. "I'm not interested in to what you did yesterday," he said after Sunday morning's practice — meaning yesterday's depth chart can change depending on what players do today and tomorrow. Most of his assistants seem to follow his cue.
Still, only 11 players will be on the field when CU trots out on offense and defense during the Sept. 1 CU-CSU game. And while several players will see action at some positions — including wide receiver, tight end and tailback — some of today's developments are significant.
First off, redshirt freshman Cody Hawkins has been named the starting quarterback. Junior Nick Nelson will be his backup. Offensive coordinator Mark Helfrich informed them of that decision during a position meeting Saturday, following the morning's scrimmage.
"We feel like he's our best guy right now, so that's who we're putting out there — the guy we think who gives us the best opportunity to move (the ball), score points and win," Helfrich said.
Nelson admitted he was disappointed with the decision, but said he's a team guy and will continue to practice hard and push Hawkins.
Hawkins had mixed emotions.
"I'm really excited that I get a chance to lead the Buffaloes, especially going into Sept. 1 against Colorado State," the quarterback said. "But it's also a bummer to see a friend like Nick be disappointed."
Helfrich pointed to Hawkins' consistency in camp as the deciding factor.
"He makes almost every routine play, and that's a big deal," Helfrich said, adding that Hawkins is working on executing big plays.
Dan Hawkins reiterated his staff's theme regarding starters and playing time by saying "If Cody Hawkins doesn't move the club and score points, 'Hey (Nelson will play instead)."
• The two other big news to come out Sunday included an injury and an academic suspension.
Freshman receiver Josh Smith bruised his kidney at some point during Saturday's scrimmage. Though Smith isn't sure when the injury occurred — it could have been during a hit he took, or when he ran into a corner wall going after a ball on a fade route — he alerted trainers to some symptoms after the practice and the bruised kidney was later diagnosed.
At this point, the medical staff doesn't know how long he will be out of action, but it's unlikely he will play vs. CSU. Helfrich said Sunday Smith had been among the top two receivers in camp this fall.
Also, junior linebacker Marcus Burton has been declared academically ineligible. He will continue to practice with the team, but can't play. He has a redshirt year available and will take it as he tries to get his grades in order.
That means walk-on Jeff Smart, the 5-11, 210-pound sophomore from Boulder, will back up starter Jordon Dizon at will linebacker. At mike — the other inside linebacker — senior R.J. Brown (who has not played a down of linebacker in a game at CU) will start (because of Michael Sipili's indefinite suspension because of legal issues) and sophomore walk-on Jake Duren will back him up.
• Other notable positioning on the depth chart are: Wes Palazzi and Devin Head are penciled in as the team's starting guards. Head said after practice, though, OL coach Jeff Grimes is emphasizing this "is a starting point," and things could change depending on who shows up to play in practice every day.
The entire second string OL is made up of true freshmen, including OT Matt Bahr, LG Mike Iltis, C Kai Maiava, RT Ryan Miller and RT Sione Tau. Keep in mind, Grimes is cross training several o-linemen and has said if a starter goes down, he may fill in with the next best player — which could mean a player listed No. 2 at another position.
Patrick Williams (x) and Scotty McKnight (z) are atop the depth chart at receiver. Anthony Perkins and Anthony Wright continue to battle for the backup safety position behind Ryan Walters.
• Beginning this morning, practices are closed to the public. (Sunday practices will be open to the public once the season starts). But there were two new signs inside the practice field facility Sunday. A large sign greeted players as they came inside the gates that read "DETAILS." On the far fence, the words "1990 NATIONAL CHAMPIONS" has been hung.


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Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium).
In this condition, blood or fluid collects in the pericardium, the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get enough blood.
Cardiac tamponade can occur due to:
Other possible causes include:
Cardiac tamponade occurs in about 2 out of 10,000 people due to disease.
Other symptoms that may occur with this disorder:
There are no specific laboratory tests that diagnose tamponade. Echocardiogram is very often used to help make the diagnosis. This test may be done at the bedside in emergency cases.
A physical exam may show:
Other tests may include:
Cardiac tamponade is an emergency condition that needs to be treated in the hospital.
The fluid around the heart must be drained as quickly as possible. Pericardiocentesis is a procedure that uses a needle to remove fluid from the tissue that surrounds the heart (pericardial sac).
A surgical procedure to cut and remove part of the pericardium may also be done. This is known as surgical pericardiectomy or pericardial window.
Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.
Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.
The cause of tamponade must be found and treated.
Cardiac tamponade is a medical emergency. If the fluid or blood is not quickly removed from the pericardium, death can occur quickly.
The outcome is often good if the condition is treated promptly. However, tamponade may come back.
Go to the emergency room or call the local emergency number (such as 911) if symptoms develop. Cardiac tamponade is an emergency condition that needs immediate medical attention.
Many cases are not preventable. Knowing your personal risk factors may help you get early diagnosis and treatment.
Review Date:
Reviewed By: Norman S. Kato, MD, Surgeon with the Cardiac Care Medical Group, Encino, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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LEGALS: IN THE PROBATE COURT OF COUNTY OF MUSCOGEE STATE OF GEORGIA RYNE AUSTIN RAINES, MINOR ESTATE NO. PC 2016EM___________ NOTICE Date of mailing, if any: N/A Date of second publication, if any: 9/15/2016 TO: JAMES DEAN RAINES, JR. You are hereby notified that...More info Email a friend
LEGALS: ÒAll persons having claims against the Estate of Bettie Phillips Spikes, late of Muscogee County, GA, deceased, are hereby requested to present the same, properly itemized and verified to Andrew Phillip Spikes, 3465 Cathryn Drive, Columbus, GA 31906, for...More info Email a friend
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If you're an artist or someone who appreciates a beautiful piece of artwork, then you know that whether it's an original painting or a quality print or even a very special sentimental treasure, a good frame completes the look. When you buy a watercolour or have a special photograph that you want to display, the right frame can complement the piece perfectly.
We as qualified and professional framers will ensure you get exactly what you need and can recommend the most suitable frame, as well as expertly completing framing for your convenience.
Someone once shared with us a concept and we are proud now to hold it high as our mission statment:
"Our commission is to protect and preserve the worlds largest private collection of cultural heritage."
In other words the greatest things of value are in private homes not in galleries or museums. We look forward each day to help all of you tell a story about the things you hold dear.
With all our products made-to-measure, we also have access to restoration services, and can help you carefully restore original fine art and photographs, as well as antique frames. Or we can help you have such treasures Digitally restored. So just get in touch with our friendly team for more information to see how we can help.
No matter what you need, when it comes to custom picture framing on the Sunshine Coast, Caloundra Framing is the ideal choice.
Monday - Thursday 9.00am - 5.00pm
9.00am - 4.00pm
Saturday 10.00am - 12pm
Sunday Closed
Appointments available outside of normal hours.
07 5492 7577


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London, UK – 20 November, 2012: UK-based data centre and estate-wide energy management specialist, Unite Technologies, held a highly successful conference and reception for existing and prospective customers at London's Savoy Hotel on Thursday 1st November. Attended by around 100 delegates from predominantly large enterprise organisations, this was the first event organised by Unite since its acquisition by Panduit Corporation earlier this year.
Entitled 6 Zone Infrastructure Management for Data Centres and Beyond, speakers from Unite Technologies and Panduit provided case studies, expert advice and guidance on the latest developments and technologies involved in data centre and estate-wide physical infrastructure management and asset tracking.
An important part of the conference agenda focused on Unite's future plans post acquisition, including how its proven energy, power, security and environmental management solutions will complement Panduit's innovations in the infrastructure management space and expand the Panduit Unified Physical InfrastructureSM portfolio.
Just some of the topics discussed included:
- Evolving physical infrastructure management in data centres and estate wide applications
- 6 Zone Energy Management – how it continues to evolve and expand, delivering a highly modular and granular range of solutions within the data centre, telecoms and estate energy management space
- Data centre infrastructure optimisation
- Connectivity and asset management in the data centre and estate
About Panduit
Panduit is a world-class developer and provider of leading-edge solutions that connect, manage and automate the physical infrastructure. Panduit Unified Physical Infrastructure℠ (UPI) based solutions help customers integrate core business systems for a smarter, unified business foundation. Our robust partner ecosystem, global staff, and unmatched service and support make Panduit a valuable and trusted partner. (www.panduit.com)
About Unite Technologies
Unite Technologies is a leading provider of data centre energy management, access control, security and environmental monitoring solutions to IT and Facilities Management. Headquartered in Usk, South Wales and offices in London and New York, Unite Technologies operates on a global basis working closely with major 'blue chip' organisations, predominately in the Financial, Petrochemical, Hosting and Telecoms, Broadcast, Retail, Security, Local Government and Blue Light sectors. The company has an established worldwide network of resellers, systems integrators and OEMs which are fully supported by Unite's specialist sales and support teams throughout the world. www.unitetechnologies.com


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State plans lottery for firewood lotsDecember 09,2012State plans lottery
for firewood lots
WATERBURY Vermonters will have a chance to cut their own firewood from state forests.
This year, roadside lots are available in Plymouth, Shrewsbury, North Duxbury, Orange, Roxbury, Johnson, Groton, and Westmore.
The lottery for the cut-your-own lots opens on Jan. 2 and ends Jan. 18.
Lottery winners pay $30 for a lot that yields about three cords of wood from trees marked for removal. The firewood is suitable for the 2013 home heating season.
Lottery winners will be notified in March.
Registrations are available at the Vermont Department of Forests, Parks and Recreation website at www.vtpr.org or call 241-3678 for more information.MORE IN This Just InMONTPELIER A pending deal between the state and federal governments will give a big boost to... Full StoryWOODFORD A North Carolina man was killed when his motorcycle crashed Friday morning in a... Full StoryMANCHESTER Voters will be asked at town meeting to allow the use of $15,000 from a reserve... Full Story
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Simple Design Needed
This project received 16 bids from talented freelancers with an average bid price of $6 USD / hour.Get free quotes for a project like this
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Project Budget$2 - $8 USD / hour
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I need a design similar to a website. Layout will remain the same, you have to change the graphical design only.
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Posttraumatic Stress Disorder (PTSD) can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may have felt afraid or felt that you had no control over what was happening.
Anyone who has gone through a life–threatening event can develop PTSD. These events can include:
After the event, you may feel scared, confused, and angry. If these feelings do not go away or get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities. Getting Started
General Information: An overview of the condition, including symptoms, risk factors, diagnosis, treatment and medications
Self–Management: Understand and track the condition through use of various health tools
Caregiver Information: Caregiver resources and when to get additional help
Reviewed/Updated Date: May 2009
Clinical Advisory Board Sponsor: Ken Weingardt
Clinical Subject Matter Experts: Jessica Hamblen, Anna Rosenberg
Patient Education Subject Matter Experts: Mara Davis
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