In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

• An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
• The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
• Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

I look forward to hearing your thoughts on the attached paper at the session on Friday. The paper is part of a larger project on how we should regulate conduct that is socially productive, but poses some risk of harm to others. The official technique for risk regulation in the modern administrative state is some form of cost/benefit analysis: we tote up the expected social benefits and expected social costs of alternative courses of conduct, and opt for that course that is expected to generate the largest aggregate benefits (net of costs). There is a vast and growing critical literature on the normative, conceptual, and administrative problems with cost/benefit analysis. I agree with many of those criticisms. But my particular interest in this project is the objection raised to any aggregative procedure, on the familiar deontological ground that it fails to respect the distinct rights and interests of individuals. Accepting the moral impulse behind that objection as understandable, maybe even compelling, the question I want to address is whether nonconsequentialists have offered—or could offer‐‐ any coherent alternative to aggregation in this context.

The short answer is, I don’t think so. I want to underscore that this is not a broadside attack on nonconsequentialist principles or a categorical defense of consequentialism. It is a domain‐specific concern. For reasons I touch on briefly in this chapter, I think that deontological principles by their nature are the wrong tools to solve the fundamental problems raised by accidental (unintended) harms, and that this reality has been obscured by the limited and somewhat peculiar focus of the immense philosophical literature on harm to others.

While these larger concerns are in the background, this chapter mostly focuses on the central deontological objection to aggregative solutions to regulating potentially harmful conduct: that it violates our duty not to act in a fashion that will result in harm to others.

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