East Asia News & Politics Thread: China, South Korea, Japan...

At least 10,000 people were killed in the Chinese army's crackdown on pro-democracy protesters in Beijing's Tiananmen Square in June 1989, according to a newly released British diplomatic cable that recounts the bloodshed in gruesome detail.

The document, made public more than 28 years after the event, describes injured girls being bayoneted, bodies being ground up by armoured vehicles and human remains being flushed into the sewers.

"Minimum estimate of civilian dead 10,000," the then British ambassador Alan Donald said in the secret telegram to London seen by AFP at Britain's National Archives.

The estimate, given on June 5, 1989, the day after the crackdown, is almost 10 times higher than that commonly accepted at the time of several hundred to more than a thousand dead.

But experts questioned by AFP said the 10,000 figure seemed credible.

Donald's account gives horrific details of the violence unleashed on the night of June 3-4, when the army entered Beijing to end seven weeks of protests on Tiananmen Square, the symbolic heart of Communist power.

During their advance, armoured personnel carriers "opened fire on the crowd (both civilians and soldiers) before running over them in their APCs", wrote the ambassador.

He said his source was a person who "was passing on information given him by a close friend who is currently a member of the State Council" — the Chinese cabinet.

He said the source had previously proved reliable "and was careful to separate fact from speculation and rumour".

Once the soldiers arrived in Tiananmen Square, "students understood they were given one hour to leave square but after five minutes APCs attacked," Donald wrote.

"Students linked arms but were mown down including soldiers. APCs then ran over bodies time and time again to make 'pie' and remains collected by bulldozer. Remains incinerated and then hosed down drains."

"Four wounded girl students begged for their lives but were bayoneted," Donald said, adding: "Army ambulances who attempted to give aid were shot up."

At the end of June 1989, the Chinese government had said suppression of the "counter-revolutionary riots" had killed 200 civilians and several dozen police and military.

- 'Primitives' -

Nearly three decades after the crackdown, the communist regime continues to forbid any debate on the subject, mention of which is banned from textbooks and the media, and censored on the Internet.

There was no sign of reaction to the report on Chinese social media, where an army of online censors blocks any reference to the Tiananmen crackdown and most things critical of the Communist Party.

Donald said the atrocities were committed by the 27th Army, who he described as "60 percent illiterate and are called primitives".

He said the crackdown had created deep rifts within the military and that "some members of the State Council considered that civil war is imminent".

As to the credibility of the toll, former student protest leader Xiong Yan, who is now an American citizen, said: "I think it's reliable."

China scholar Jean-Pierre Cabestan also said the figure was credible, pointing out that recently declassified US documents gave a similar assessment.

"That's two pretty independent sources which say the same thing," said Cabestan, a professor at Hong Kong Baptist University.

The British ambassador's report was "not particularly astonishing considering how crowded it was in Beijing, the number of people mobilised" against the Chinese government, said Cabestan, who was in the Chinese capital in the days leading up to the crackdown.

Former student leader Feng Congde, now also based in the United States, pointed out that Donald had sent another telegram three weeks later putting the death toll at between 2,700 and 3,400.

Feng said that toll was quite credible and fitted with figures from the Chinese Red Cross, who at the time estimated 2,700 fatalities, and by student committees based on hospital reports.

Taiwan is proof that a country can make a swift and huge change to its health care system, even in the modern day.

The United States, in part because of political stalemate, in part because it has been hemmed in by its history, has been unable to be as bold.

Singapore, which we wrote about in October, tinkers with its health care system all the time. Taiwan, in contrast, revamped its top to bottom.

Less than 25 years ago, Taiwan had a patchwork system that included insurance provided for those who worked privately or for the government, or for trade associations involving farmers or fishermen. Out-of-pocket payments were high, and physicians practiced independently. In March 1995, all that changed.

After talking to experts from all over the world, Taiwan chose William Hsiao, a professor of economics at the Harvard T.H. Chan School of Public Health, to lead a task force to design a new system. Uwe Reinhardt, a longtime Princeton professor, also contributed significantly to the effort. (Mr. Reinhardt, who died last month, was a panelist on an Upshot article comparing international health systems in a tournament format.) The task force studied countries like the United States, Britain, France, Canada, Germany and Japan.

In the end, Taiwan chose to adopt a single-payer system like that found in Medicare or in Canada, not a government-run system like Britain’s. At first, things did not go as well as hoped. Although the country had been planning the change for years, it occurred quite quickly after democracy was established in the early 1990s. The system, including providers and hospitals, was caught somewhat off guard, and many felt that they had not been adequately prepared. The public, however, was much happier about the change.

Today, most hospitals in Taiwan remain privately owned, mostly nonprofit. Most physicians are still either salaried or self-employed in practices.

The health insurance Taiwan provides is comprehensive. Both inpatient and outpatient care are covered, as well as dental care, over-the-counter drugs and traditional Chinese medicine. It’s much more thorough than Medicare is in the United States.

Access is also quite impressive. Patients can choose from pretty much any provider or therapy. Wait times are short, and patients can go straight to specialty care without a referral.

Premiums are paid for by the government, employers and employees. The share paid by each depends on income, with the poor paying a much smaller percentage than the wealthy.

Taiwan’s cost of health care rose faster than inflation, as it has in other countries. In 2001, co-payments for care were increased, and in 2002, they went up again, along with premiums. In those years, the government also began to reduce reimbursement to providers after a “reasonable” number of patients was seen. It also began to pay less for drugs. Finally, it began to institute global budgets — caps on the total amount paid for all care — in the hope of squeezing providers into becoming more efficient.

Relative to the United States and some other countries, Taiwan devotes less of its economy to health care. In the early 2000s, it was spending 5.4 percent of G.D.P., and by 2014 that number had risen to 6.2 percent. By comparison, countries in the Organization for Economic Cooperation and Development spend on average more than 9 percent of G.D.P. on health care, and the United States spends about twice that.

After the most recent premium increase in 2010 (only the second in Taiwan’s history), the system began to run surpluses.

This is not to say the system is perfect. Taiwan has a growing physician shortage, and physicians complain about being paid too little to work too hard (although doctors in nearly every system complain about that). Taiwan has an aging population and a low birthrate, which will push the total costs of care upward with a smaller base from which to collect tax revenue.

Taiwan has done a great job at treating many communicable diseases, but more chronic conditions are on the rise. These include cancer and cardiovascular and cerebrovascular disease, all of which are expensive to treat.

The health system’s quality could also be better. Although O.E.C.D. data aren’t available for the usual comparisons, Taiwan’s internal data show that it has a lot of room for improvement, especially relating to cancer and many aspects of primary care. Taiwan could, perhaps, fix some of this by spending more.

As we showed in our battle of the health care systems, though, complaints can be made about every system, and the one in the United States is certainly no exception. For a country that spends relatively little on health care, Taiwan is accomplishing quite a lot.

Comparing Taiwan and the United States may appear to be like comparing apples and aardvarks. One is geographically small, with only 23 million citizens, while the other is vast and home to well above 300 million. But Taiwan is larger than most states, and a number of states — including Vermont, Colorado and California — have made pushes for single-payer systems in the last few years. These have not succeeded, however, perhaps because there is less tolerance for disruption in the United States than the Taiwanese were willing to accept.

Regardless of which health system you might prefer, Taiwan’s ambition showed what’s possible. It took five years of planning and two years of legislative efforts to accomplish its transformation. That’s less time than the United States has spent fighting over the Affordable Care Act, with much less to show for it.

Palau, a tiny Pacific nation of just 21,500 people, has vowed to resist renewed pressure from Beijing to cut its diplomatic links with Taiwan.

One of just 20 nations keeping formal diplomatic ties with Taiwan, Palau was named in a notice issued by Chinese officials last month warning travel agencies that it was illegal to advertise group tours to destinations not on China’s approved list.

But while a clampdown on Chinese visitors would hurt the Palau economy, the nation said it had no plans to switch its allegiance away from Taipei.

“Palau is a country of laws, it is a democracy and we make our own decisions,” said Olkeriil Kazuo, spokesperson for Palau’s president, Tommy Remengesau.

China is the biggest source of visitors to tourist-dependent Palau, comprising roughly half the 113,000 visitors to the archipelago so far this year, according to the Asian Development Bank.

Tensions between China and Taiwan, a self-governed island that Beijing regards as a renegade province, were heightened last year when the Democratic Progressive party led by Tsai Ing-wen won power, replacing the more China-friendly Nationalist party, or Kuomintang.

The republication of China’s list of approved travel destinations reflects Beijing’s toughening approach towards Taiwan’s allies, experts said.

Mr Kazuo said Beijing’s exclusion of Palau from its list of approved destinations — a measure in place for several years but to date not strictly enforced — has “never affected” the country.

Tourism growth “largely determines economic performance” — the sector accounted for more than half of Palau’s gross domestic product in 2015 — and a “significant” decline in visitors from China, Japan and Taiwan this year has already caused “uncertainty over near-term economic prospects”, according to the ADB.

Dilmei Louisa Olkeriil, Palau’s ambassador to Taiwan, said that, if the number of Chinese visitors suddenly fell, “of course the [tourism] industry will hurt”.

“If China says, ‘no tourists go to Palau’, then no tourists will come to Palau, we need to be aware of that,” she said, adding that Palau must further diversify its source markets to “protect us from something like this”.

In the decades since China was admitted to the UN in 1971, most countries withdrew recognition of the Republic of China, as Taiwan is formally known, to establish relations with Beijing. In a dogged battle for recognition, both sides have long used promises of financial aid and infrastructure spending to attract allies.

But policymakers in Beijing have now decided that China’s political objectives are not “something they can obtain purely by soft power alone”, said Lauren Dickey, a researcher in cross-Strait relations and a visiting fellow at National Chengchi University in Taipei.

“Even when China has relied on the carrot, the threat of the stick has always been there. The difference is the stick is actually being used this time,” Ms Dickey said.

William Stanton, former head of the American Institute in Taiwan, the unofficial US embassy in Taipei, said it was clear China was “stepping up pressure” against Taiwan.

“It seems to be an important shift,” he said, noting that President Xi Jinping of China had signalled a toughening foreign policy at the Communist party congress in October. “They are a bully and they are going to get worse unless people stand up to them,” said Mr Stanton, who now lectures at National Taiwan University.