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When Henry Paulson first visited Beijing in 1991 as a banker, cars still shared major roads with horses.

"I remember getting into a taxi that drove too fast on a two-lane highway ... [that was] clogged with bicycles and horses pulling carts," says the former secretary of treasury under George W. Bush. "You still saw the hutongs — the old neighborhoods [with narrow streets] — which were very, very colorful and an important part of life."

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A 2006 photo of former U.S. Treasury Secretary Henry Paulson meeting with Xi Jinping in Hangzhou, China. Jinping became president of China in 2013. Qilai Shen/Bloomberg via Getty Images hide caption

itoggle caption Qilai Shen/Bloomberg via Getty Images

A 2006 photo of former U.S. Treasury Secretary Henry Paulson meeting with Xi Jinping in Hangzhou, China. Jinping became president of China in 2013.

Qilai Shen/Bloomberg via Getty Images

Since the early '90s, Paulson has returned to China more than 100 times, as the head of Goldman Sachs and U.S. Treasury Secretary. Along the way, he has watched China become the world's second biggest economy.

"Now the country puts up half of all new buildings on Earth. It consumes and produces 50 percent of the cement in the world, 50 percent of the steel, the coal," he says. Most of the old hutongs have been replaced by glass and steel skyscrapers.

Eventually, China will likely surpass the U.S. and become the largest economy in the world, Paulson says. "But it's also a country with monumental challenges. There's as much danger in overemphasizing China's strength as in underestimating its potential."

Dealing With China

An Insider Unmasks the New Economic Superpower

by Henry M. Paulson, Jr.

Hardcover, 430 pages | purchase

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In his new book, Dealing With China: An Insider Unmasks the New Economic Superpower, Paulson describes some of the major challenges China faces as its people become richer.

At the top of that list is government censorship. China has the fastest-growing urban population in the world, with nearly 650 million people living in cities. At the same time, the government continues to severely limit political freedom.

Paulson says that approach isn't sustainable.

"Today you have the president of the country emphasizing the party being tougher on certain human rights, and on the media and internet — toughening up censorship," he says. "I look at this and I tell them, 'You live in an information economy, and you're not going to succeed if you close people off from information and innovation.' "

Both publicly and privately, China's president — Xi Jinping — is very direct about his own views on this topic, and his colleagues' views.

"They don't aspire to have a Western-style, multiple-party democracy," Paulson says. "They don't aspire to have Western values. Jinping believes that the future of the country, the stability, is dependent on a strong Chinese Communist Party.

"I feel quite strongly that won't work long term," Paulson says. As more people prosper, they'll demand information and rights.

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But Paulson does give the government credit for listening — and responding — to its people.

"The Chinese leadership over time has been pretty pragmatic in terms of understanding the mood of the people," he says. "Today they are focused on the things people care about the most: fighting corruption; restoring property rights to peasants; working to clean up the environment; working to ameliorate some of the income inequality."

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The global economy won't sink this year, thanks to the oceans of cheap oil keeping it afloat.

That's the bottom line of the World Economic Outlook, released Tuesday by the International Monetary Fund. The 2015 pace of economic growth will tick up to 3.5 percent, helped along by lower energy costs and weaker currencies.

The world's economic expansion is "modest and uneven," IMF economist Olivier Blanchard said. But still, it's a bit better than the 3.4 percent pace of growth set during each of the past two years.

Since June, oil prices have tumbled by about 50 percent. At the same time, a rebounding U.S. economy has pushed up the value of the dollar, allowing other countries to benefit from having cheaper currencies.

"Large movements in relative prices, whether exchange rates or the price of oil, create winners and losers," Blanchard said. That means oil-producing countries, especially Russia, are getting hurt, but many oil-importing countries in Europe and Asia are doing better, he said.

What's the one thing that would boost growth for everyone?

"More public investment," Blanchard said. Countries do need to reduce their budget deficits, but at the same time, they need to build a lot more infrastructure, he said. That would mean building more roads, bridges, ports and airports, which would create jobs and increase future economic activity.

What's the one thing that could hurt everyone?

The IMF fears "a cascade of disruptive adjustments" if the U.S. Federal Reserve were to raise interest rates quickly and significantly.

The world's economic prospects will be hashed over later this week when global leaders gather for the IMF and World Bank annual spring meetings, held in Washington, D.C.

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Anne Koller was diagnosed with late-stage colon cancer in 2011 and has been fighting it since.

But it's not just the cancer she's fighting. It's the bills.

"We went from drugs that cost a few hundred dollars for a course of therapy that might be a month or six months or a year, to drugs that were costing $10,000 a month."

- Dr. Neal Meropol, oncologist, University Hospitals, Cleveland

"Think of those old horror flicks," she says. "The swamp creature ... comes out and is kind of oozy, and it oozes over everything."

Koller, who just turned 65 years old, is petite, and sports a stylish auburn wig. When she was able to work, Koller was in the corporate world and safely middle-class, with health insurance and plenty of savings.

At first, she was too sick to deal with the bills. They piled up.

"You start looking at these bills," Koller says, "and, as much as you know it's expensive, the shock itself is like, 'What?' "

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Anne Koller was diagnosed with Stage III colon cancer in 2011. She has been fighting cancer and the medical bills ever since. Sarah Jane Tribble/WCPN hide caption

itoggle caption Sarah Jane Tribble/WCPN

Anne Koller was diagnosed with Stage III colon cancer in 2011. She has been fighting cancer and the medical bills ever since.

Sarah Jane Tribble/WCPN

Her response was to begin asking her doctors about the cost of the treatments they recommended.

Middle-income patients are — more than ever — feeling the weight of that financial burden, says Dr. Neal Meropol, an oncologist at University Hospitals in Cleveland. He took over Koller's care a couple of years ago.

"Patients are weighing this in their calculus now," Meropol says.

High-deductible health plans and soaring drug prices are to blame, he says, and a sea change happened when a new generation of drug therapies got FDA approval for treatment in the late 1990s.

"We went from drugs that cost a few hundred dollars for a course of therapy that might be a month or six months or a year, to drugs that were costing $10,000 a month," Meropol says.

Total cost of cancer care in the U.S. is projected to reach more than $150 billion by 2020, according to the National Cancer Institute. The U.S. Centers for Disease Control and Prevention released a study last year that found that, compared to people without a cancer diagnosis, cancer survivors are less likely to work, and more likely to struggle financially. Another study, out of Washington state, found that the longer a cancer patient survived, the higher the rate of bankruptcy.

University of Chicago's Dr. Jonas de Souza argues that it's time for oncologists to begin considering the financial consequences as a real side effect to cancer care.

"We talk about hair loss," de Souza says. "We talk about numbness and tingling in the hands and feet. We talk about, 'This chemotherapy will cause low blood counts.' Right. Should we also be talking about, 'Well, this chemotherapy is expensive?' "

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He and Meropol are part of a growing field of researchers studying the impact of costs for cancer patients.

Anne Koller will tell you cancer does cause financial stress.

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"Here's what happens," Koller says. "I was talking about that swamp thing ... but you know, OK, you go to collections. You end up with a court thing. I had been talking to the hospital, asking for help — nothing, nothing. Finally, they went to a sliding payment scale."

Her credit is ruined. So she's driving an old car. Small expenses, like an Internet connection, are out of the question. And there are other challenges.

"Socially, things change a lot," she says. "You talk to people and, if you dare, say, 'God, you know, I can't afford this,' for instance." Or, " 'Let's go out to lunch,' on the day you can eat. You ... think twice about it."

Koller says she wishes more financial information had been given earlier in her treatments. She is now using the very last of her savings to pay the bills — and, still, some are going unpaid.

This story is part of NPR's reporting partnership with WCPN and Kaiser Health News.

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In 2012, Republicans unanimously made a vow. If their party captured the White House, they would totally repeal President Obama's signature achievement, the Affordable Care Act.

In 2016, they've added something else: the total reversal of Obama's signature foreign policy achievements, his outreach to hostile nations.

In his second term, Obama has been working to restore diplomatic relations with Cuba for the first time in more than half a century. His administration has also been negotiating a deal to limit Iran's nuclear program.

A number of GOP presidential contenders have vowed a U-turn on both policies, no matter what may happen between now and the next inauguration day.

That's why Obama's foreign policy may shape up to be the Obamacare of 2016. Republicans pledge to erase Obama's acts as soon as a Republican is again sitting behind the Oval Office desk.

Sen. Marco Rubio, R-Fla., is among those calling for a reversal. Rubio spoke with NPR on Monday, the day he announced his presidential campaign. Rubio, who's Cuban-American, made the announcement at Miami's Freedom Tower, where Cuban exiles fleeing Fidel Castro's regime once came to receive federal support. Rubio is a fierce critic of Cuba's government and of warming U.S. relations with it.

Would Rubio really re-break diplomatic relations with Cuba if elected?

"Absolutely," he says. He wants "free and fair elections" in Cuba, and says U.S. policy can provide "major leverage."

This was largely the approach that U.S. presidents took for generations — until December 2014, when Obama said that more than half a century of waiting was long enough.

Rubio is just as definite on Iran.

The U.S., other world powers, and Iran have negotiated a framework agreement under which Iran would accept limits on its nuclear program, in exchange for the lifting of global economic sanctions.

Rubio contends that what one president gives, the next may take away. "What [Obama] is banking on," Rubio says, "is that he is going to use a national security waiver to lift the sanctions," a move that allows the president to act without a vote in Congress. "We would simply re-impose the sanctions."

Rubio says he would make this move even if other world powers and the United Nations failed to follow suit, though he admits his move "wouldn't be as effective" that way.

Such a move could lead to a new confrontation with Iran. Rubio says he hopes to avoid war, and (as with Cuba) buy time until the regime changes.

The prospect of such dramatic foreign policy reversals raises many questions. The simplest is this: Could a President Rubio (or Walker, or Cruz, or...) really do these things?

Strictly speaking, yes.

A president can break diplomatic relations with Cuba, even if they've just been restored.

Supporters of Obama's Cuba policy, however, expect a different dynamic. The U.S. opening to Cuba may in time bring economic opportunities. American entrepreneurs won't be clamoring to rupture ties again: they will be clamoring to modify the longstanding economic embargo against Cuba that block U.S. business deals.

In theory, a president could also tear up an agreement made by his predecessor. George W. Bush did this in 2001, withdrawing from a climate treaty signed by Bill Clinton.

But when Republicans first floated the idea of walking away from the Iran deal — a notion mentioned in an open letter to Iran signed by 47 Republican senators — Iran's foreign minister insisted an agreement would be binding on the United States. Withdrawal from it would be a "blatant violation of international law."

Obama is just as scornful. In an interview this month, we asked him about GOP contender Scott Walker, who had promised to break the Iran deal on "day one." Obama replied that this was a "foolish" idea, which would undermine the presidency, and suggested that Walker agree "after he's taken some time to bone up on foreign policy."

Republicans are boning up. Most elections don't turn on foreign policy, and by 2016, this one may not either. But there's plenty of discussion of it.

Republicans are running against the retiring president's foreign policy legacy. That means they also get one more chance — one last chance — to run against Obama.

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Marco Rubio

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