Asking China to Act Like the U.S.

WASHINGTON — A fundamental tenet of foreign policy says that nations will seldom voluntarily act against what they have determined, for whatever reason, to be their own national interest. 

Somebody needs to tell that to the United States when it comes to China, many foreign policy experts say.

A key part of America’s relationship with China now turns on a question that is, at its heart, an impossible conundrum: How to get Beijing to make moves that its leaders don’t think are good for their country?

From economics to climate change to currency to Iran and finally culminating with North Korea last week, America has sought to push, prod and cajole China, to little or no avail.

Beijing has resisted letting its currency rise because it depends on the cheap yuan to drive its export-heavy economy. China has balked at stiff sanctions to rein in Iran’s nuclear ambitions because it needs access to Iran’s oil and gas fields to fuel its own growth. Beijing doesn’t want to curb carbon emissions because its ability to lift hundreds of millions of people into the middle class over the coming years is directly linked to its increased use of energy.

And, finally, Beijing has recoiled at reining in its unruly neighbor to the east, as the Obama administration implored it to do last week, because it doesn’t want to destabilize North Korea’s secretive, hermit regime to an extent that could lead to the government’s collapse and the North’s eventual reunification with South Korea.

“China isn’t 100 percent on board with U.S. efforts,” said Andrew L. Oros, an Asia expert at Washington College, in Chestertown, Md., because Beijing is “concerned with the idea of a unified Korea with U.S. troops stationed there.”

That concern has left a succession of American governments attempting the impossible.

“Basically, the U.S. wants China to do what the U.S. wants it to do,” said Rodger Baker, vice president for strategic intelligence at Stratfor, a geopolitical risk analysis company. “We want to make sure that the world stays as the United States would like to see the world. Which means making China subservient to us in some cases. In the case of North Korea, the Chinese see it as the United States pushing its policy on China and not allowing the Chinese to make their own policy, while removing from China one of the tools that it has decided it needs for its own interests.”

In this case, that tool would be a divided Korea, with a North Korea that is beholden to and wholly dependent on China serving as a buffer against American encroachment in China’s backyard.

But the conundrum extends far beyond last week’s double Korean-peninsula whammy, which involved not only North Korea’s deadly shelling of a South Korean military installation, but also the disclosure of a just-completed centrifuge plant that could one day enable North Korea to enrich uranium into nuclear fuel and add to its arsenal of 8 to 12 nuclear weapons. All of that led to the broad effort from the Obama administration to enlist China to rein in Pyongyang.

So far, China is not biting, and will not bite, on either North Korea or the host of other issues, some experts say, until the United States changes not only its tactics, but the entire way that American governments view Beijing.

“We’re still struggling with a post-unilateralist hangover,” said David Rothkopf, author of “Running the World: The Inside Story of the National Security Council and the Architects of American Power.”

That hangover, he says, leads Americans to believe “that we’re the sole remaining superpower and the objective of our foreign policy is to get people to go along with that. To fall into step with our worldview. But the reality is, that’s not what the future holds.”

Rather, Mr. Rothkopf argues, the United States is heading into a future in which countries like China, with independent sources of power, are not reliant on or easily influenced by the United States, and so are pursuing their own national interests. 

Some Obama administration officials say that they are aware of this shift, and have begun to adapt their strategy toward China accordingly. Mr. Obama’s recent trip to India, in which he endorsed India’s bid for a permanent seat on the United Nations Security Council, should be viewed not only in the context of America and India, a senior administration official said, but America and China as well. “It’s part of a strategy in which China risks seeing the United States forming alliances in its neighborhood, which may not be to Beijing’s liking,” said the official, who spoke on condition of anonymity.  

Likewise, Mr. Obama’s decision to accelerate the deployment of an American aircraft carrier group to the Yellow Sea for joint exercises with South Korea was meant in part to drive home a message to Beijing. Aware that China doesn’t like any kind of display of American military might in its backyard, Obama administration officials are hoping to change Beijing’s cost-benefit analysis until it decides that restraining North Korea is a lesser evil than seeing more American sailors playing war games outside its door.

“That’s not a threat,” the administration official said. “It’s a reality.”

But in the past three weeks, the United States has seen, in rapid-fire succession, China’s own determination to push back against American demands. At the Group of 20 leaders summit meeting in Seoul on Nov. 11, Mr. Obama tried to get the world to come down hard on China for its devalued currency, and saw Beijing turn the tables. Instead of America leading the world in hectoring China, Beijing led the world in hectoring the United States for a recent “quantitative easing” move by the Federal Reserve that international critics said had artificially lowered the value of the American dollar.

Coming so soon after the G-20 debacle, the North Korea impasse demonstrates the limits of American attempts to bend Beijing to its will, and a new reality that is emerging: a Sino-American relationship that, foreign policy experts say, must be carefully calibrated to balance American demands against what Beijing can be realistically persuaded to do.

Some conservative critics of the Obama administration say that the United States can manage this new reality only if it is tougher in its demands of Beijing. “I would turn up the pressure on China to reunite the Korean peninsula,” said John Bolton, who was the United States ambassador to the United Nations in the Bush administration. “This division is unnatural, and they need to get on the right side of history. And in the meantime, I would strangle North Korea economically, ramping up the P.S.I. activities,” a reference to military maneuvers in the Yellow Sea.

“I’d cut off all food aid; that’s turning up the pressure,” Mr. Bolton said. “What Obama’s doing right now is just rhetoric.”

Mr. Rothkopf, for his part, counters that it will take more than pressure to get Beijing to yield. He says that the United States must first determine the areas where China won’t bend, and work with Beijing to find compromises so that America is not in the impossible situation of trying to tell China to act against its own national interests. And the United States should work furiously to build up alliances with other countries in the region, he said.

“We have moved from the cold war era of bipolar reality through the brief bubble of sole superpower unilateral fantasy into a world of a new multipowered system which requires old-fashioned balance-of-power diplomacy,” Mr. Rothkopf said. The result, he said, may be that “all of a sudden, the old cobweb-infested State Department is more important than it’s been in many, many years.”

China Sees New Talks to Ease Rising Korean Tensions

The United States and South Korea began naval exercises on Sunday that were meant as a warning to North Korea for recent provocations, including the deadly artillery attack last week on an island populated by South Koreans in the Yellow Sea. 

At the same time, China called for an emergency meeting of the six principal countries involved: itself, Japan, North Korea, South Korea, Russia and the United States. Reacting to the growing sense of crisis in the region, China’s foreign ministry hastily called a press briefing Sunday afternoon, with Vice Foreign Minister Wu Dawei calling for “emergency consultations” to be held in early December in Beijing.

The call came as a senior Chinese diplomat returned home after an unscheduled visit to Seoul. The state counselor in charge of foreign affairs, Dai Bingguo, met President Lee Myung-bak of South Korea.

During the meeting, Mr. Lee pressed China to do more for peace in the region, according to a South Korean version of the events. The South Korean president’s office said in a statement that Mr. Lee also asked China to “maintain a more responsible and fair attitude in its policies involving the two Koreas,” an apparent prod to put more pressure on North Korea to stop its provocations.

Mr. Wu said his colleague’s talks in Seoul had gone well, adding that “China is opposed to all actions that undermine peace and stability on the peninsula.” North Korean artillery was heard Sunday on the island, though no shells landed there and South Korea considered it just a drill, according to a spokesman for South Korea’s Joint Chiefs of Staff. The North Koreans also shot off artillery on Friday, after a visit by a U.S. general to the island, called Yeonpyeong.

The announcement last week of the naval exercises raised already heightened tensions, angering both North Korea and its patron, China, and stirring intense speculation in the South Korean news media about whether the North would respond violently.

After the announcement, China warned against “any military act” in its exclusive economic zone without permission, according to the state-run Xinhua news agency. But virtually all the waters to the west of the Korean Peninsula fall within that 200 nautical mile limit. It was not immediately clear if the U.S. and South Korean flotilla, which included the United States aircraft carrier George Washington, had sailed into that area.

China’s diplomatic efforts came after days of entreaties from Washington and its allies to exert a moderating influence on North Korea.

China’s diplomatic initiative also included the planned talks with Choe Tae- bok, chairman of North Korea’s Supreme People’s Assembly, who will pay an official visit to China starting Tuesday.

The United States has hoped that China would use its leverage over North Korea to restrain it from any further attacks, but so far China has not rebuked the North’s leaders, at least in public. And when China did finally make a strong public statement late last week on the attack — the one warning against military actions in its economic zone — it directed its pique at the United States for the naval exercises.

The show of force was designed both to deter further attacks by the North and to signal to China that unless it reins in its unruly ally, it may see an even larger U.S. presence in the vicinity.

The flurry of diplomacy over the weekend followed days of recriminations by both Koreas. On Saturday, North Korea accused South Korea of using civilians as human shields around military bases on the island. The accusation, reported by the North’s official news agency, is apparently an effort to redirect South Korean outrage over the barrage, which killed two civilian construction workers and two South Korean marines.

“If the U.S. brings its carrier to the West Sea of Korea at last, no one can predict the ensuing consequences,” the report said, using the Korean name for the Yellow Sea.

Also on Saturday, at least two protests were staged in Seoul that criticized both North Korea’s leader, Kim Jong-il, for the attack and South Korea’s president for what many here see as the military’s failure to make more than a token response.

The bombardment of the island was the first attack on a civilian area since the 1950-53 Korean War, and it enraged the South Koreans far more than previous provocations by the North, including its nuclear weapons tests and the sinking in March of a South Korean warship that killed 46 sailors. Despite the findings of an international investigation, North Korea denies responsibility for the sinking.

The North has said that the Tuesday attack was carried out in response to South Korean artillery drills earlier that day on the island, which sits within sight of the North Korean mainland. On the morning of the attack, North Korea warned South Korea not to conduct the drills.

Citing those warnings, North Korea said that it had made “superhuman efforts to prevent the clash at the last moment.” It also offered an uncharacteristic show of remorse, calling the civilian deaths “very regrettable.” The comments were apparently an attempt to present the North’s view of events to the South Korean public, which has reacted to the Tuesday attack with uncharacteristic vehemence toward the North.

Ian Johnson contributed reporting from Beijing, and Su-Hyun Lee and Sharon LaFraniere from Seoul. Zhang Jing contributed research from Beijing.

M.B.A.’s in Japan Struggle for Respect

TOKYO — For many businesspeople looking to re-invent themselves by getting an M.B.A., there is one well-worn question: How much more will I be worth after obtaining the actual degree?

In Japan, the answer is not simple — nor is it a given that one’s perceived value will increase at all. In fact, most companies have been known to look askance at such an accomplishment, sometimes placing recent M.B.A. recipients in unrelated fields, or trying to re-acclimate their Japanese employees who have spent years overseas earning a degree.

“They believe in business know-how gained on the job, not in the classrooms,” said T.W. Kang, a Tokyo-based businessman who holds an M.B.A. from Harvard Business School. “They’d say you can’t learn it there. You have to learn it with your feet.”

But, partly in an effort to counter those perceptions, some business schools themselves are working to make their M.B.A. degrees more relevant.

Administrators of Japanese business schools like Hitotsubashi University’s Graduate School of International Corporate Strategy and Globis Business School, both in Tokyo, say they seek to offer a business education that takes into account the local corporate culture.

Hitotsubashi’s dean, Christina Ahmadjian, said that students at her school are required to take a course in “knowledge creation.”

“Students read about the philosophy of Zen Buddhism, among many other things, and learn about how leading Japanese companies have innovated through sharing of ‘tacit knowledge’ — knowledge that is best communicated through long-term, close, personal relationships,” she said. “This is the polar opposite of the Wall Street view of things.”

This evolving approach to M.B.A.’s comes at a time when there is something of a boom for a mid-career business education in Japan.

Since the Ministry of Education began accrediting graduate schools meant to train business and management professionals seven years ago, more than 30 schools have sprung up in large cities like Tokyo and Osaka, typically run as evening and weekend programs stretched over two-year to four-year periods.

The growth in Japan has been fed by two major factors: A weak economy has pushed more professionals to seek degrees and certificates to improve their job prospects, and big Japanese companies have largely stopped sponsoring expensive overseas degrees the way they once did for their employees.

“Japanese companies have drastically reduced the number of people they send overseas,” Ms. Ahmadjian said about acquiring M.B.A.’s.

Despite the boon to the schools in Japan, the history of questioning the value of M.B.A.’s continues to present a hurdle, consultants and others say.

Mr. Kang, who has served on the boards of both Japanese and American companies, said the majority of Japanese managers at large corporations viewed business knowledge learned at school with suspicion and skepticism, bordering on disdain.

This notion runs deeper at engineering-driven, manufacturing companies, he said.

“They have so much trust for craftsmanship and believe that business school theory compromises that concept,” Mr. Kang said.

A friend of his, a chief financial officer of a leading Japanese company, recently shared an anecdote with him: During a lecture on financial management given by the chief financial officer, one engineer got up and asked, “Is it O.K. to pursue profits?”

That question — already settled in most business cultures — is characteristic of Japanese engineers, whose job it is to overcome technological hurdles rather than seek profits.

“Japanese shokunin, or craftsmen, feel satisfied if they realize and beat next-to-impossible expectations that customers demand of them,” Mr. Kang said. 

Ms. Ahmadjian raised a similar point. “Many Japanese managers cling to the belief that the same ‘Japanese system’ of management that drove Japan’s economic rise decades ago is still appropriate and that everything from the U.S. is somewhat corrupt and wrong,” she said.

But she said that she perceived a growing interest in a more integrated approach, one that includes both Japanese and American principles. “A model of management is clearly emerging in the aftermath of the financial crisis — and it is going to be a combination of both.”

The phenomenon of questioning the value of business degrees took off in the 80’s and 90’s, when large Japanese companies were still sending their young employees in droves to American and European M.B.A. programs. To some skeptics back in Japan, “the M.B.A.s were considered a high-class English class,” Mr. Kang said.

When some students came back, a common practice was to place them in a most unrelated business arena, like domestic sales, furthest from what they learned at overseas schools.

The idea was to reorient the employee who may have become too westernized or become overconfident with their M.B.A. knowledge.

That issue, however, is fast disappearing, said Ms. Ahmadjian, partly because Japanese employers have found the practice counter-productive.

“I think those days are over,” she said. “Now, corporations use the returning M.B.A.s more effectively and immediately.”

In fact, Reiji Shibata, chief executive of Indigo Blue, a human resources consulting firm in Tokyo and formerly the chief executive of a number of Japanese firms, said Japanese M.B.A. holders generally do fine in the management consulting field, but not necessarily in the general business context.

“They have a tendency to overemphasize logic,” he said. “Their approach at times leads to clashes and dead ends and deals don’t go through as a result. This is especially so when you are working with different types of customers and partners.”

Mr. Shibata, who served as head of Mercer Human Resource Consulting, a leading American human resources advisory firm, in Japan, said the less-than-stellar reputation of M.B.A.’s may have resulted from the way they had been treated in the Japanese business world in the first place. “It appears to me that they feel they are constantly under-rated and under-estimated despite their degrees,” he said. “They have it backwards. They have to show performance first before they are recognized.”

Mr. Shibata added that this condition could lead them to flaunt and accentuate their business knowledge even more, turning off their Japanese co-workers and customers. “It is a vicious cycle,” he said.

Yoshihiko Takubo, deputy dean of Globis Business School in Tokyo, said that the fact that many young Japanese company-sponsored M.B.A. recipients quit their companies may have left a bad feeling with their employers and the Japanese business community. “But many people stayed on and became successful,” he said, adding that others who left went on to become successful entrepreneurs, including Hiroshi Mikitani of Rakuten, the leading on-line shopping mall in Japan, and Tomoko Namba of DeNA, a leader in on-line auctions. Both went to Harvard Business School.

Mr. Takubo said M.B.A. degrees are useful, but for Japanese business people, some adjustments need to be made. He said, for example, that instructors at Globis do not teach that corporate managers are a class of people divorced from the realities of business. “Japanese managers have to know, understand and identify closely with the front-line,” he said.

He also teaches that brandishing one’s M.B.A. knowledge is not a good idea.

“We tell students never to use technical terms like the ‘five forces’ of sales, when they go back to work,” he said. “That is going to turn people off.”

Ms. Ahmadjian said that while Japanese employers may not yet instantly recognize the value of the business degree, they have come to value the overall experiences that come with it.

“Japanese companies are doing much more M&A abroad and they are in need of employees who can function in diverse global teams who can manage work forces of non-Japanese,” she said. “They are much more aware of that than they were 10 years ago.”

The Pilgrims Were ... Socialists?

Ah, Thanksgiving. A celebration regardless of creed; a time for all Americans to come together after a divisive election year. 

But why take a holiday from argument? In these fractious times, even the meaning of Thanksgiving is subject to political debate.

Forget what you learned about the first Thanksgiving being a celebration of a bountiful harvest, or an expression of gratitude to the Indians who helped the Pilgrims through those harsh first months in an unfamiliar land. In the Tea Party view of the holiday, the first settlers were actually early socialists. They realized the error of their collectivist ways and embraced capitalism, producing a bumper year, upon which they decided that it was only right to celebrate the glory of the free market and private property.

Historians quibble with this interpretation. But the story, related by libertarians and conservatives for years, has taken on new life over the last year among Tea Party audiences, who revere early American history, and hunger for any argument against what they believe is the big-government takeover of the United States.

It has made Thanksgiving another proxy in the debate over health care and entitlement spending, and placed it alongside the New Deal and the Constitution on the platter of historical items picked apart by competing narratives.

There are other debates about Thanksgiving — whether the first was in Jamestown, Va., or Plymouth, Mass.; whether it was intended as a religious holiday or not. But broadly, the version passed on to generations of American schoolchildren holds that the settlers who had arrived in the New World on the Mayflower in 1620 were celebrating the next year’s good harvest, sharing in the bounty with Squanto and their other Indian friends, who had taught them how to hunt and farm on new terrain.

All very kumbaya, say Tea Party historians, but missing the economics lesson within.

In one common telling, the pilgrims who came to Plymouth established a communal system, where all had to pool whatever they hunted or grew on their lands. Because they could not reap the fruits of their labors, no one had any incentive to work, and the system failed — confusion, thievery and famine ensued.

Finally, the governor of the colony, William Bradford, abolished this system and gave each household a parcel of land. With private property to call their own, the Pilgrims were suddenly very industrious and found themselves with more corn than they knew what to do with. So they invited the Indians over to celebrate. (In some other versions, the first Thanksgiving is not a feast but a brief respite from famine. But the moral is always the same: socialism doesn’t work.) The same commune-to-capitalism, famine-to-feast story is told of Jamestown, the first English settlement, in 1607. Dick Armey, the former House majority leader and Texas congressman who has become a Tea Party promoter, related it as a cautionary tale in a speech to the National Press Club earlier this year.

Rush Limbaugh repeats the Thanksgiving story of Plymouth every year, reading it from a chapter in one of his books titled “Dead White Guys, or What Your History Books Never Told You.” (Some details change; one year, he had the Pilgrims growing organic vegetables.)

The version is also taught in a one-day course called “The Making of America,” which became popular with Tea Party groups across the country after Glenn Beck recommended the work of its author, W. Cleon Skousen, who died in 2006. Tea Party blogs have reposted “The Great Thanksgiving Hoax” from a Web site celebrating the work of the libertarian economist Ludwig von Mises, a favorite of Ron Paul devotees. The post concludes: “Thus the real reason for Thanksgiving, deleted from the official story, is: Socialism does not work; the one and only source of abundance is free markets, and we thank God we live in a country where we can have them.”

Leave aside the question of whether this country is on the march to socialism (conservatives say yes, and blame the Democrats). What does the record say?

Historians say that the settlers in Plymouth, and their supporters in England, did indeed agree to hold their property in common — William Bradford, the governor, referred to it in his writings as the “common course.” But the plan was in the interest of realizing a profit sooner, and was only intended for the short term; historians say the Pilgrims were more like shareholders in an early corporation than subjects of socialism.

“It was directed ultimately to private profit,” said Richard Pickering, a historian of early America and the deputy director of Plimoth Plantation, a museum devoted to keeping the Pilgrims’ story alive.

The arrangement did not produce famine. If it had, Bradford would not have declared the three days of sport and feasting in 1621 that became known as the first Thanksgiving. “The celebration would never have happened if the harvest was going to be less than enough to get them by,” Mr. Pickering said. “They would have saved it and rationed it to get by.”

The competing versions of the story note Bradford’s writings about “confusion and discontent” and accusations of “laziness” among the colonists. But Mr. Pickering said this grumbling had more to do with the fact that the Plymouth colony was bringing together settlers from all over England, at a time when most people never moved more than 10 miles from home. They spoke different dialects and had different methods of farming, and looked upon each other with great wariness.

“One man’s laziness is another man’s industry, based on the agricultural methods they’ve learned as young people,” he said. 

Bradford did get rid of the common course — but it was in 1623, after the first Thanksgiving, and not because the system wasn’t working. The Pilgrims just didn’t like it. In the accounts of colonists, Mr. Pickering said, “there was griping and groaning.”  

“Bachelors didn’t want to feed the wives of married men, and women don’t want to do the laundry of the bachelors,” he said.

The real reason agriculture became more profitable over the years, Mr. Pickering said, is that the Pilgrims were getting better at farming crops like corn that had been unknown to them in England.

As for Jamestown, there was famine. But historians dispute the characterization of the colony as a collectivist society. “To call it socialism is wildly inaccurate,” said Karen Ordahl Kupperman, a historian at New York University and the author of “The Jamestown Project.” “It was a contracted company, and everybody worked for the company. I mean, is Halliburton a socialist scheme?”

The widespread deaths resulted mostly from malaria. Tree ring studies suggest that the settlement was also plagued by drought.

But the biggest problem, Professor Kupperman said, was the lack of planning. The Virginia settlers came to the New World thinking that they could find gold or a route to the Pacific Ocean via the Chesapeake Bay, and make a quick buck by setting up a trading station like others were establishing in the East Indies.

“It was just wishful thinking,” she said, “a failure to recognize that these things are really, really difficult.”

The Tea Party’s take on Thanksgiving may have its roots in the cold war.

Samuel Eliot Morison, the admiral and historian who edited Bradford’s “Of Plymouth Plantation,” titled the chapter about Bradford ending the common course “Indian Conspiracy; Communism; Gorges.”

But it is important to note that he was writing in 1952, amid great American suspicion of the Soviets. “The challenges of the cold war and dealing with Russia are reflected in the text,” Mr. Pickering said.

Likewise, Cleon Skousen, the author of the “Making of America” textbook, was an anticommunist crusader in the 1960s. (His term for Jamestown was not socialism but “secular communism.”)

“What’s going on today is a tradition of conservative thought about that early community structure,” Mr. Pickering said.

William Hogeland, the author of “Inventing American History,” agreed. “Across the political spectrum, there’s a tendency to grab a hold of some historical incident and yoke it to a current agenda,” he said. “It doesn’t always mean there’s no connection, but often things are presented as historical first, rather than as part of the agenda first.”

And indeed, many can play this game.

Professor Kupperman, for instance, said the Jamestown story reminded her mostly of the Iraq war.

“It was kind of like the idea that the Iraqis would greet us with flowers,” she said.

Foundations Help Bring Discipline to Philanthropy

When Andy Lim returned to Singapore two years ago after studying law in Britain, he sat down with his father, the chief executive of a real estate fund management company, to discuss how the family could start making its philanthropic gifts in a more organized way.

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Raquel Marin

“My father has always been active in giving out ad hoc checks to various causes over the years,” Andy Lim said. “Giving through a foundation is the next logical step towards creating a more structured method of giving.”

The two decided to set up the Lim Hoon Foundation, with initial capital of 10 million Singapore dollars, or $7.7 million, to help young people who did not have access to education.

So far, the foundation has given several scholarships and is paying for the maintenance of a pool at a school for children with special needs. Only interest is disbursed to help preserve the foundation’s capital.

The foundation is now considering bigger projects, including some in China, with guidance from the philanthropy services arm of the Swiss bank UBS. But in organization and in philosophy, it is still very much family-oriented, Andy Lim said.

“Our ‘board meetings’ are simply conducted over dinner at home, where I run viable projects past my father for approval, comments and ideas,” he said.

The Lim family is part of a broader trend. The number of millionaires in the Asia-Pacific region grew by 25 percent last year, catching up with Europe for the first time, according to the latest annual World Wealth report from Merrill Lynch and Capgemini. The combined wealth of Asia-Pacific’s high net worth individuals rose by more than 30 percent to $9.7 trillion in 2009.

Demand for philanthropy-related advisory services also rose in the region, the report noted, adding that, more generally, philanthropists today “are likely to demand the same kind of professional advice in making these types of investments as they do when considering investments designed to meet other financial and lifestyle objectives.”

That, wealth management experts say, is a big change from years past.

“When I was growing up in Hong Kong, I used to see people writing checks to Community Chest — that was their idea of charity,” said Thelma Kwan, head of wealth advisory, Asia Pacific, at Barclays Wealth.

“Now people are more into philanthropy,” she said. “Philanthropy comes with a little more structure, more strategy and governance built around it, and also more involvement after a donation has been made. There’s usually a more well-thought-through long-term strategic direction, rather than just signing a check.”

Chew Gek Khim, deputy chairman of the Tan Chin Tuan Foundation set up by her late grandfather in 1976, said that “when you give from your own pocket, it tends to be ad hoc and dealt with when an appeal comes. When one sets up a foundation, more thought is given to the idea of giving; systems and processes are usually set up along with the foundation to ensure that giving is at least for a period of time.”

“From a structural standpoint, giving through a foundation is more likely to be sustained, simply because of the discipline involved when one sets up a foundation,” she added.

While there is no minimum sum required to set up a foundation or a trust, bankers recommend starting with at least $1 million, given the costs associated with running the structure.

Michael Troth, Asia head of Citi Trust in Singapore, pointed out that clients needed to decide how involved they wanted to be in the daily running of the foundation and the composition of its board, as well as consider a number of other questions. “Does the client and his family want to be on the committee? How should the committee operate? How do they vote? How do they receive requests for grants?”

Ms. Kwan said it was important for clients to put good governance in place, with checks and balances on the committee making the decisions, and to devote time and resources to due diligence. “If you’re giving money in another country — for example, building a school in a foreign country — you may want to do regular inspections of what’s going on and the progress made,” she said.

Once all the structures are in place, benefactors may face a different problem altogether: finding viable, sustainable projects that fit the foundation’s vision and objectives.

“We have received so many proposals for projects in the past year, but many do not meet our foundation’s ethos of sustainable giving and do not pass our due diligence processes,” Andy Lim said of his family foundation.

Woon Shiu Lee, head of wealth planning, trust and insurance at Bank of Singapore, said it was important for clients to remember that once they set up a structure for private wealth planning purposes, they are no longer the legal owner of the assets within the structure. “They have to maintain a clear distinction between themselves and the structure to ensure that they derive the optimal tax benefits from the structure,” he said.

Financial benefits aside, philanthropic giving through a family trust or foundation can also pay personal benefits. Andy Lim said the experience had helped him and his father grow closer.

“When I was much younger, my dad and I would start small projects like building model tanks or airplanes together,” he said. “We grew distant through my rebellious teenage years, and it’s only since starting this foundation together that we really got a chance to reconnect.

“It is as if we have gone full circle and gone back to the days where we would do little projects together. I am enjoying this aspect very much.”

Dear S.E.C., Please Make Brokers Accountable to Customers

Dear Mary Schapiro:

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Robert Neubecker

Bucks

Requiring Brokers to Put Their Customers First

By TARA SIEGEL BERNARD

Please share your letters to Mary Schapiro, the chairwoman of Securities and Exchange Commission.

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Tara Siegel Bernard

is a personal finance reporter with The Times.

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Sallie Krawcheck of Bank of America says the financial industry needs plain-English disclosures.

From what I’ve been reading, you’re busy working on the rules that will set in motion the new Wall Street overhaul law. That is why I’m writing to you today. I know that one of the rules you’re considering would require stock and insurance brokers to put their customers’ interests before their own.

Most of the consumer advocates and other experts I’ve spoken with in recent weeks have said that they’re pretty confident you will go ahead and write the new rule (even though the financial overhaul law stops short of requiring it). But many of them are concerned that the new rule won’t go far enough. Quite frankly, so am I.

By my count, you’ve already received more than a hundred letters from various stakeholders — some were thoughtful, some outright absurd — on this issue (which from here on out I’ll just call fiduciary duty). So please consider this an official comment letter, written on behalf of the average investor, many of whom are relying on their brokers’ advice to achieve some semblance of financial security in retirement.

Many of these consumers don’t even realize that their brokers — who often call themselves financial advisersinvestment advisers, who are required to put their customers’ interests first. Sure, brokers must recommend “suitable” investments, but we all know that it’s a much weaker standard and leaves too much room for potential abuse — one that can line the pocket of the broker at the expense of the investor. — aren’t held to the same standards as

It’s hard to argue against a new rule, though the insurance industry will probably continue to try. Surprisingly, Wall Street had, at least outwardly, been more receptive to the notion of a uniform fiduciary duty for both brokers and investment advisers. So I was quite confused after I read the study commissioned by the Securities Industry and Financial Markets Association, the trade group for the big banks and brokers, which came to the bizarre conclusion that putting customers first was, in fact, bad for customers. Were you just as perplexed?

I called the association for clarification. Apparently, I had gotten it wrong. It wasn’t going to “hurt” investors, an executive told me, it was just going to cost those investors more money. What was even more curious, however, were some of the issues that the association chose to study. As Barbara Roper, an advocate at the Consumer Federation of America, put it, “They chose to analyze a mythical situation that will never occur.”

Take commissions, for instance. The study seems to assume brokers will no longer be able to charge commissions under a new rule, which couldn’t be further from the truth. Didn’t the association read the Dodd-Frank Act? It specifically says receiving commissions “shall not” be considered a violation of a fiduciary standard. Yet the association chose to calculate how much customers would be forced to pay in fees, if the brokers had to shift from a commission-based pay structure to a fee-based one. The study estimated it would cost $460 more a year for someone with $200,000 in assets. But that’s a nonissue.

What they should have studied was how they might eliminate the conflicts inherent in charging commissions. A former Wall Street broker told me the reason they are often so pushy is because, absent the sale of a product, they don’t get paid. Why not study ways to manage this issue? Or contemplate other ways to charge for advice?

The study also claims that adopting a broad fiduciary standard could limit the number of products that brokers can offer to a client. Right now, when the brokerage firm sells you a security, like a stock from its own account, or a municipal or corporate bond that it had a hand in underwriting, it stands to profit from the transaction. That’s a conflict of interest, which means the broker needs consent from the client to move ahead.

But this is a weak argument against the new rule. As Mercer Bullard, who serves on the Securities and Exchange Commission Investor Advisory Committee pointed out to me, there are thousands of brokers who already act as fiduciaries because they have discretionary control over their customers’ accounts. So how do they manage the issue? “It’s a blatant attempt to mislead commentators on the issues instead of grappling with the real issue,” he said. “And there is a real issue.”

As you know, there are plenty of ways that brokers can manage this conflict — the S.E.C. just needs to clarify exactly when this type of activity is O.K. For instance, perhaps brokers should obtain consent from a client at the beginning of a relationship, which grants permission to trade in liquid securities, but to check before, say, selling the customer an illiquid security with very subjective values. And naturally, requiring brokers who are giving advice to ensure the transaction is in the client’s best interest.

When I asked Ira Hammerman, the association’s general counsel, about all of this, he said that the industry didn’t want a watered-down rule. “It’s all nonsense,” he said. “If the new law of the land will result in a fiduciary standard, that is fine. We support that. We just want the S.E.C. to define it, and provide guidance as to how a multifaceted financial institution can comply.”

He offered a hypothetical. What if, for instance, a customer who also happens to be an employee of Apple doesn’t want to sell a concentrated position in that company’s shares, even if the broker advises the client to do so? Financial advisers who serve as fiduciaries deal with this all the time, especially with new clients. It can easily be solved with a plain-English disclosure, no? 

Of course, we don’t want to simply paper over the many conflicts with these disclosures — disclosing a conflict is not the same as trying to eliminate it. Even Sallie Krawcheck, who oversees Merrill Lynch’s brokers as president of Bank of America global wealth and investment management, said that the industry needed to do a better job of transforming its “telephone book” disclosures into something more digestible. “That is going to be a challenge,” she added, noting that she, too, was for the fiduciary standard so that “clients can make decisions about their advisers without having a Ph.D. in regulatory science.”  

But for that to happen, the rule really does need to be as strong as the one that financial advisers already adhere to (and the law does say it should). Or else, we’re right back to where we started, and that raises the question of whether a broker’s fiduciary duty will always be slightly less pure than a financial planner operating outside the brokerage ecosystem.

(I haven’t even gotten to some of the arguments put forth by the insurance industry. Did you see the comment letter from the Independent Insurance Agents and Brokers of America? They said that identifying the “ideal product among many different alternatives is not as simplistic, straightforward and clear-cut as some mistakenly believe.” You can’t blame them for saying that. I mean, have you tried to read an equity index annuity contract lately?)

It’s impossible for the new rule to resolve all the conflicts, but it needs to attack them head on.

Even though the political climate has shifted, this should not be a partisan issue. Don’t give in to the argument that the additional regulation will stifle capital formation, or that the costs will be so high that the small investors may be pushed aside. There are plenty of financial planners who would be happy to take their business.

Sure, it’s going to cost brokerage firms hundreds of millions of dollars and untold hours to put this new standard into effect. But they should look at those costs as a marketing expense. After all, a fiduciary standard is going to provide brokers with a whole new sales pitch.

That’s why it’s so important that the S.E.C. ensures there’s something substantial behind that inevitable pitch. Consumers shouldn’t be left to wonder whose interests come first.

North Korea Issues Warning as Artillery Fire Rattles Island

SEOUL, South Korea — Tension mounted on Friday near a South Korean island bombarded this week by North Korea as Pyongyang’s military again fired artillery, this time in what appeared to be a drill on its own territory. The North’s state-run media warned that a planned United States-South Korean military exercise could push the Korean Peninsula closer to “the brink of war.”

Meanwhile, South Korea struggled with the domestic political fallout from Tuesday’s deadly attack, which exposed the weakness of South Korean defenses and brought public criticism of President Lee Myung-bak for failing to retaliate more forcefully. On Friday, he appointed a new defense minister, whose predecessor resigned on Thursday for failing to keep forces at ready in an area that has seen repeated military clashes with North Korea.

North Korea’s state-run news agency lashed out at South Korean and American plans to hold a joint training exercise on Sunday in Yellow Sea waters near the island.

The exercises are to include the American aircraft carrier George Washington. Using its characteristically bellicose language, the Korean Central News Agency said that the North’s army was “getting ready to give a shower of dreadful fire and blow up the bulwark of the enemies.”

“The situation on the Korean Peninsula is inching closer to the brink of war due to the reckless plan of those trigger-happy elements to stage war exercises targeted against” the North, the dispatch warned.

The arrival of the George Washington is intended as a warning to the North and a show of support for its ally, South Korea, following the Tuesday attack, the first by North Korea to strike civilians since the 1950-53 Korean War.

On Friday morning, the United States made another show of solidarity when the commander of American forces in South Korea, Gen. Walter L. Sharp, visited Yeonpyeong Island to survey the damage from the hour-long bombardment, which killed four South Koreans — two civilians and two marines.

But North Korea remained defiant, firing off artillery rounds right after the general’s visit. The rounds did not fall in South Korean territory but rattled nerves on the island nonetheless. A spokesman for the South Korean Defense Ministry, Kwon Ki-hyeon, said the shots appeared to stay within North Korean territory, suggesting they were part of a drill — or perhaps an effort to spook the South Korean garrison on the small island, which sits within sight of the North Korean mainland.

News flashes of the artillery sounds set off a brief wave of alarm in Seoul, where the Tuesday attack has stirred anxiety and outrage because it harmed civilians. Residents gathered in front of television screens or paused in their tracks to check cellphone screens for updates.

The events this week have raised concerns in Seoul that the North may respond violently during Sunday’s naval exercises. Some media reports cited parallels between the K.C.N.A. report Friday and a warning issued by North Korea hours before Tuesday’s artillery barrage, which the North said was in response to a South Korean military maneuver held near the island earlier that day.

While reading the reclusive North’s intentions can be a challenge, experts said the Friday report was more vaguely worded, suggesting that it was intended as a broad warning to the United States and South Korea not to stray too closely to North Korean territory.

“It is a message that North Korea will not yield if it believes the joint military training infringes on its sovereignty,” said Kim Keun-shik, a professor of international relations at Kyungnam University.

To thwart another North Korean attack, the South Korean president, Mr. Lee has ordered reinforcements to the 4,000 troops now on Yeonpyeong and four nearby islands as well as more heavy weapons. But his government has come under intense domestic criticism for what has been depicted as an inadequate retaliation for Tuesday’s attack, which South Korean troops on the island responded to with a smaller artillery counterattack.

Mr. Lee appointed Kim Kwan-jin, a former chairman of South Korea’s joint chiefs of staff as defense minister. Earlier on Friday, South Korean officials had named another appointee for the spot, but then withdrew the name when he apparently failed to pass an internal vetting process.

South Koreans have begun to get their first look at the damage to Yeonpyeong’s small fishing town from reports by South Korean journalists describing a scene of devastation with dozens of homes burned out or flattened by the hour-long attack.

Television footage showed streets in the island’s main fishing port deserted by all but stray dogs after most civilians had evacuated the island. The island’s garrison of marines remained on high alert, with South Korean officials saying they were on the lookout for a reaction from North Korea to Sunday’s military exercise.

While the island bristles with artillery batteries and machine gun nests, South Korean officials said its forces were unable to fully respond to Tuesday’s attack because they have been trained and equipped to thwart a North Korean amphibious assault, not fight off a prolonged artillery bombardment.

While the garrison did shoot back with 155-millimeter cannons, officials in the Blue House, South Korea’s version of the White House, said plans are afoot to reinforce the garrison with other types of heavy weaponry.

In his visit to the island, General Sharp expressed sympathy for those killed and said many lives appeared to be saved by the quick response of local civil defense officials, who herded townspeople into bomb shelters. He also called on North Korean People’s Army to refrain from further attacks and to hold talks on the incident.

Su-Hyun Lee contributed reporting from Seoul.

Eating the Irish

What we need now is another Jonathan Swift.

Fred R. Conrad/The New York Times

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Most people know Swift as the author of “Gulliver’s Travels.” But recent events have me thinking of his 1729 essay “A Modest Proposal,” in which he observed the dire poverty of the Irish, and offered a solution: sell the children as food. “I grant this food will be somewhat dear,” he admitted, but this would make it “very proper for landlords, who, as they have already devoured most of the parents, seem to have the best title to the children.”

O.K., these days it’s not the landlords, it’s the bankers — and they’re just impoverishing the populace, not eating it. But only a satirist — and one with a very savage pen — could do justice to what’s happening to Ireland now.

The Irish story began with a genuine economic miracle. But eventually this gave way to a speculative frenzy driven by runaway banks and real estate developers, all in a cozy relationship with leading politicians. The frenzy was financed with huge borrowing on the part of Irish banks, largely from banks in other European nations.

Then the bubble burst, and those banks faced huge losses. You might have expected those who lent money to the banks to share in the losses. After all, they were consenting adults, and if they failed to understand the risks they were taking that was nobody’s fault but their own. But, no, the Irish government stepped in to guarantee the banks’ debt, turning private losses into public obligations.

Before the bank bust, Ireland had little public debt. But with taxpayers suddenly on the hook for gigantic bank losses, even as revenues plunged, the nation’s creditworthiness was put in doubt. So Ireland tried to reassure the markets with a harsh program of spending cuts.

Step back for a minute and think about that. These debts were incurred, not to pay for public programs, but by private wheeler-dealers seeking nothing but their own profit. Yet ordinary Irish citizens are now bearing the burden of those debts.

Or to be more accurate, they’re bearing a burden much larger than the debt — because those spending cuts have caused a severe recession so that in addition to taking on the banks’ debts, the Irish are suffering from plunging incomes and high unemployment.

But there is no alternative, say the serious people: all of this is necessary to restore confidence.

Strange to say, however, confidence is not improving. On the contrary: investors have noticed that all those austerity measures are depressing the Irish economy — and are fleeing Irish debt because of that economic weakness.

Now what? Last weekend Ireland and its neighbors put together what has been widely described as a “bailout.” But what really happened was that the Irish government promised to impose even more pain, in return for a credit line — a credit line that would presumably give Ireland more time to, um, restore confidence. Markets, understandably, were not impressed: interest rates on Irish bonds have risen even further.

Does it really have to be this way?

In early 2009, a joke was making the rounds: “What’s the difference between Iceland and Ireland? Answer: One letter and about six months.” This was supposed to be gallows humor. No matter how bad the Irish situation, it couldn’t be compared with the utter disaster that was Iceland.

But at this point Iceland seems, if anything, to be doing better than its near-namesake. Its economic slump was no deeper than Ireland’s, its job losses were less severe and it seems better positioned for recovery. In fact, investors now appear to consider Iceland’s debt safer than Ireland’s. How is that possible?

Part of the answer is that Iceland let foreign lenders to its runaway banks pay the price of their poor judgment, rather than putting its own taxpayers on the line to guarantee bad private debts. As the International Monetary Fund notes — approvingly! — “private sector bankruptcies have led to a marked decline in external debt.” Meanwhile, Iceland helped avoid a financial panic in part by imposing temporary capital controls — that is, by limiting the ability of residents to pull funds out of the country.

And Iceland has also benefited from the fact that, unlike Ireland, it still has its own currency; devaluation of the krona, which has made Iceland’s exports more competitive, has been an important factor in limiting the depth of Iceland’s slump.

None of these heterodox options are available to Ireland, say the wise heads. Ireland, they say, must continue to inflict pain on its citizens — because to do anything else would fatally undermine confidence.

But Ireland is now in its third year of austerity, and confidence just keeps draining away. And you have to wonder what it will take for serious people to realize that punishing the populace for the bankers’ sins is worse than a crime; it’s a mistake.

Give Thanks for ... Eel?

Easton, Conn.

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Roberto Parada

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AS the story goes, Squanto — a Patuxet Indian who had learned English — took pity on the Pilgrims of Plymouth Colony who had managed to survive that first brutal winter, and showed them how to plant corn, putting a dead fish in each hole where a seed was planted. But before that, before the ground had even fully thawed, he taught them a perhaps more valuable skill: how to catch a fatty, nutritious fish that would sustain them in the worst of winters. And this food item, likely on the table of that first Thanksgiving, would have carried special significance to those remaining colonists. Eels — a forgotten staple of our forefathers.

Indeed, eel was the dinner that Pilgrims were given on the very day after they made peace with Massasoit, the sachem, or leader, of the region. The following account is from “Mourt’s Relation,” mostly written by a Plymouth resident, Edward Winslow: “Squanto went at noon to fish for eels. At night he came home with as many as he could well lift in one hand, which our people were glad of. They were fat and sweet. He trod them out with his feet, and so caught them with his hands without any other instrument.”

Eels don’t like cold water, and spend the winter balled up, bodies twisted together in the mud. In the frigid months they were usually caught with fork-like spears, the eels pinned between the tines. The fish proved essential to the endurance of the Pilgrims, and it is fitting that a river near Plymouth Colony was named Eel River.

The peculiar life cycle of the freshwater eel was almost tailor-made for the harvest season, and for stockpiling food for the winter. Eels are born in the middle of the Atlantic Ocean, hatched as little larvae shaped like willow leaves. From there, they drift and swim toward the coast, where they enter the mouths of freshwater rivers and streams in the spring. I have observed them in that season when plates of ice still line the banks of tidal streams, “like pieces of slender glass rods shorter than a man’s finger,” as Rachel Carson described them.

The inches-long transparent juvenile fish then make their way upstream to feed and grow. They stay for 10 to 30 years, until one autumn when they feel the urge to return to the Sargasso Sea, the warm clockwise gyre more than 1,000 miles east of Bermuda in the Atlantic Ocean, to spawn and die.

In the 17th century, the autumn runs to the saltwater would have been epic, overlapping the hurricane season when an abundance of rainwater swelled the rivers. They moved in great numbers at night, en masse, sometimes forming braids with their bodies to overcome obstacles, or large balls to roll over gravel bars that separate the mouths of rivers from the sea. On wet nights eels would even travel overland, relentless in their quest to return to their natal womb in the deep ocean.

Traditionally, Native Americans caught eels in autumn by building large river weirs, two large stone walls stretching from the banks to the center of the river, forming a large V with the trap at the vortex on the downstream side. If the conditions were right — a steady rain to raise the river level and no moon — they could catch several tons of eel in one night. The fish was then dried and smoked for the winter, manna of huge and reliable proportions. There is evidence that East Coast Indians were using these stone and wood weirs 5,000 years ago, and probably earlier.

But if eels were an essential food for Native Americans and early colonists, then why are they neglected as a food fish in modern America? Why isn’t eel, instead of turkey, the symbol of colonial resilience and gratitude?

Eels are not easy to like. Their sliminess, as well as their general tendency to stir human uneasiness, has made them a tough species to champion. Eels are conspicuously absent from news reports about our beleaguered wild fisheries (whose demise has been brought ever closer by the calamitous oil spill in the Gulf of Mexico). We hear instead about the magnificent emblems of our seas: the bluefin tuna, the swordfish, the Atlantic salmon, the cod.

But the eel is also disappearing, thanks largely to a multibillion dollar market driven by Japan’s appetite for the fish. Juveniles caught in river mouths are shipped to farms in China, where they are raised to edible size and then flown to sushi restaurants around the world — giving eels one of the least sustainable routes to market of any fish, wild or farmed. What’s more, global warming, dams and pollution have taken a heavy toll on eel populations in North America and Europe.

What can we do to restore this creature that once made up 25 percent of the fish biomass of Eastern rivers? For starters, we can rehabilitate the local wetlands that nurture eels at all life stages, because eels historically fed not only humans, but nearly everything in the system, from striped bass to cormorants.

We also need to deal with dams that prevent the free exchange of life from the sea to inland waterways. If dams cannot be removed, then they should be equipped with eel ladders to help juvenile eels travel upstream. And hydrodam operators should consider turning off the turbines, which wound or kill eels, for a few hours on autumn nights during the peak of vast unseen migrations of the adult fish to the sea.

Let’s be thankful, then, for the beautiful but forgotten Thanksgiving eel. And let’s accept responsibility for preserving the fish that did so much to sustain the newcomers to these shores so many years ago.

James Prosek is the author, most recently, of “Eels: An Exploration, From New Zealand to the Sargasso, of the World’s Most Mysterious Fish.”

Study Finds No Progress in Safety at Hospitals

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time. 

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

“It is unlikely that other regions of the country have fared better,” said Dr. Christopher P. Landrigan, the lead author of the study and an assistant professor at Harvard Medical School. The study is being published on Thursday in The New England Journal of Medicine.

It is one of the most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States. That report, by the Institute of Medicine, an independent group that advises the government on health matters, led to a national movement to reduce errors and make hospital stays less hazardous to patients’ health.

Among the preventable problems that Dr. Landrigan’s team identified were severe bleeding during an operation, serious breathing trouble caused by a procedure that was performed incorrectly, a fall that dislocated a patient’s hip and damaged a nerve, and vaginal cuts caused by a vacuum device used to help deliver a baby.

Dr. Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.

“Until there is a more coordinated effort to implement those strategies proven beneficial, I think that progress in patient safety will be very slow,” he said.

An expert on hospital safety who was not associated with the study said the findings were a warning for the patient-safety movement. “We need to do more, and to do it more quickly,” said the expert, Dr. Robert M. Wachter, the chief of hospital medicine at the University of California, San Francisco.

A recent government report found similar results, saying that in October 2008, 13.5 percent of MedicareDepartment of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals. beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the

Dr. Landrigan’s study reviewed the records of 2,341 patients admitted to 10 hospitals — in both urban and rural areas and involving large and small medical centers. (The hospitals were not named.) The researchers used a “trigger tool,” a list of 54 red flags that indicated something could have gone wrong. They included drugs used only to reverse an overdose, the presence of bedsores or the patient’s readmission to the hospital within 30 days.

The researchers found 588 instances in which a patient was harmed by medical care, or 25.1 injuries per 100 admissions.

Not all the problems were serious. Most were temporary and treatable, like a bout with severe low blood sugar from receiving too much insulin or a urinary infection caused by a catheter. But 42.7 percent of them required extra time in the hospital for treatment of problems like an infected surgical incision.

In 2.9 percent of the cases, patients suffered a permanent injury — brain damage from a stroke that could have been prevented after an operation, for example. A little more than 8 percent of the problems were life-threatening, like severe bleeding during surgery. And 2.4 percent of them caused or contributed to a patient’s death — like bleeding and organ failure after surgery.

Medication errors caused problems in 162 cases. Computerized systems for ordering drugs can cut such mistakes by up to 80 percent, Dr. Landrigan said. But only 17 percent of hospitals have such systems.

For the most part, the reporting of medical errors or harm to patients is voluntary, and that “vastly underestimates the frequency of errors and injuries that occur,” Dr. Landrigan said.

“We need a monitoring system that is mandatory,” he said. “There has to be some mechanism for federal-level reporting, where hospitals across the country are held to it.”

Dr. Mark R. Chassin, president of the Joint Commission, which accredits hospitals, cautioned that the study was limited by its list of “triggers.” If a hospital had performed a completely unnecessary operation, but had done it well, the study would not have uncovered it, he said. Similarly, he said, the study would not have found areas where many hospitals have made progress, such as in making sure that patients who had heart attacks or heart failure were sent home with the right medicines.

The bottom line, he said, “is that preventable complications are way too frequent in American health care, and “it’s not a problem we’re going to get rid of in six months or a year.”

Dr. Wachter said the study made clear the difficulty in improving patients’ safety.

“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”

Leah Binder, the chief executive officer of the Leapfrog Group, a patient safety organization whose members include large employers trying to improve health care, said it was essential that hospitals be more open about reporting problems.

“What we know works in a general sense is a competitive open market where consumers can compare providers and services,” she said. “Right now you ought to be able to know the infection rate of every hospital in your community.”

For hospitals with poor scores, there should be consequences, Ms. Binder said: “And the consequences need to be the feet of the American public.”