Thanks for that, Kathryn. Thanks too to the 73 (so far) commenters on my original PEPFAR post. I don’t think that’s a record comment thread, but I think I can hear Jonah gnashing his teeth anyway.
First I’ll correct an apparent error in Kathryn’s post. She writes: “contrary to what you said in your post, Derb, the Bush administration looked to support programs that encourage behavior change.”
I can’t see anything I wrote that is thus contrary. I wrote: “The subsidizing of expensive medications (the biggest part of our AIDS-relief effort, though not all of it) in fact has long-term consequences more likely to be negative than positive.”
According to Lyman and Wittels in that Foreign Affairs article I cited (which, a helpful reader tells me, non-subscribers can find in its entirety here, and which I urge all interested parties to read):
In fiscal year 2009, about 45 percent of PEPFAR’s budget was spent on treatment.
At 45 percent, “treatment” — wellnigh congruent with what I described as “the subsidizing of expensive medications” — is just what I said it is: the biggest part of our AIDS-relief effort.
Lyman and Wittels go on to note that:
That percentage will only rise in the years ahead as more people are treated and as those who have already begun treatment develop a resistance to first-line drugs and start needing more expensive second-line therapies. Thus, unless overall aid to Africa grows substantially — which is unlikely in these times of deficits and budget stress — PEPFAR, and especially PEPFAR’s treatment programs, will increasingly crowd out other health efforts.
In other words: You ain’t seen nothin’ yet.
To deal with the comments: The substantive points (no, sorry, I don’t consider “Derbyshire is a jerk” or “Brits suck” to be substantive points) are those arguing that AIDS relief to sub-Saharan Africa is so a U.S. national interest. The main arguments are:
Public health. With international travel cheap and easy, a high incidence of any infectious disease anywhere is everyone’s concern.
True; but this is properly the province of international agencies like WHO (the people who eradicated smallpox). PEPFAR is a needless duplication of effort. In any case, our first line of defense as a nation should be to deny visas to persons from affected areas, a thing Congress can do in half an hour, which costs our taxpayers nothing. (Likely, in fact, if you throw in externalities, less than nothing.)
Friends give you stuff. By showing our goodness and generosity to these afflicted nations, we cause them to love us and become our BFFs. We shall then have preferential access to their markets and commodities.
As Lyman and Wittels amply demonstrate, PEPFAR generates just what all other welfare programs generate: entitlement, resentment, and the Hegelian inversion of the giver-receiver relationship. Market- and commodity-wise, the current Race for Africa is easily being won by the Chinese, who don’t give a red [sic] cent for AIDS prevention.
Stopping the Chaos. All those AIDS orphans will grow up to be terrorists.
The argument goes that by saving lives through AIDS prevention/treatment we are helping prevent sub-Saharan African countries from turning into so many Somalias and Yemens.
This AIDS-terrorism connection seems to me a mighty stretch. How many of the several thousand terrorists on our current watchlists are AIDS orphans? (My guess: none.) Actual AIDS infection rates for Somalia and Yemen are 0.5 percent and 0.1 percent respectively, according to the CIA World Factbook.
The poverty/chaos/terrorism connection doesn’t seem to hold water anyway. The only terrorist from sub-Saharan Africa I can bring to mind is this one — a child of wealth and privilege (like Osama bin Laden).
This argument is hard to sustain even from a Bushite standpoint that the best hope for damping down terrorism is to spread democracy. PEPFAR is a hindrance to democracy-promotion, as Lyman and Wittels explain.
* * * * *
Sorry, no sale. PEPFAR serves no national interest of the U.S.A., is hindering the advance of rational government in sub-Saharan Africa, and has committed the U.S. taxpayer to indefinitely swelling expenditures in a time of national economic emergency.
Even on the assumption, which I by no means share, that a president is entitled to a vanity project or two, this one’s a stinker.
Kudos to Derb for engaging the commenters in his follow-up!
Reply to this commentLinkReport Abuse"Kudos to Derb for engaging the commenters in his follow-up!"
Though he carefully dodges the morality question. Are we not morally compelled to act when we can and are able? If one passes by an injured person in the street is the relevant question "Does helping this person serve my personal interest?"
Reply to this commentLinkReport AbuseDerb, I'm confused now. The message from your original post seemed to be that funding anti-AIDS programs was not within our national interest. Yet you say here:
"True; but this is properly the province of international agencies like WHO (the people who eradicated smallpox). PEPFAR is a needless duplication of effort. "
The US helps fund WHO. So should we cancel those checks now? How does this fit our national interest? How do you reconcile funding WHO (good) with direct funding (bad).
Reply to this commentLinkReport AbuseAh, but he does not dodge the morality question at all. You may disagree with his view of the proper role of gov't and moral imperatives, but he was quite clear where his view lies:
" It is the most elementary error, though — and certainly one no conservative should make — to confuse private charity with state action. When governments are generous, they are generous with our money, after ripping it from our pockets by force of law.
If George W. Bush, or any other wealthy American, is moved by the plight of AIDS sufferers in Africa, he is free to discharge his feelings by acts of charity. If he were to do so, no-one — no, not even I — would begrudge him the smug self-satisfaction he displays in this op-ed.
There is, however, no virtue in a government official spending your money and mine unless for some reason demonstrably connected to our national interest."
Reply to this commentLinkReport AbuseDerb's right. This is a disaster. That there could be much debate on something this obvious is surprising, but never underestimate the American need to be righteous, even while we're harming the continent we're so self-righteously helping.
Reply to this commentLinkReport Abuse>though he carefully dodges the morality question. Are we not morally compelled to act when we can and are able?
If you wish to help, you will not be stopped. Also, keep your collective helping hands from helping themselves to my collective wallet. Why is this so hard to understand?
Reply to this commentLinkReport AbuseTo Right of Center: I don't think Derb dodged the morality question in his original post. He acknowledged that individuals (and consenting groups of individuals) are perfectly free to make contributions to causes like AIDS in Africa. The proper province of that moral judgment, I assume Derb would say, lies with those discreet individuals and groups, not with a nation in the abstract, where every expenditure, no matter how well-intentioned, involves the (arguably immoral) use of funds from tax-payers who have not consented to the action in question. That latter are equally free to arrive at different conclusions on the morality of the matter--as Derb has done, obliquely, in the above post, where he argues that the effort to "help" is frought with unintended destructive consequences.
As a general matter, it's been most interesting (also sometimes maddening) to observe Derb's development on these questions in recent years. His voice adds great value and dimension to NR/NRO, even and especially when it's raised in dissent.
Reply to this commentLinkReport AbuseTo Right of Center: "Are we not morally compelled to act when we can and are able? If one passes by an injured person in the street is the relevant question "Does helping this person serve my personal interest?""
You are talking here about the Good Samaritan issue. Had the GS been a modern-day liberal (or GW), he would have left the injured crime victim to die in the ditch and started an activist campaign for an Empire-wide "ditch rescue" program. Financed by taxes collected under the threat of imminent enslavement and/or crufixion. Then he would have gone home and dislocated his shoulder patting himself on the back for being such a wonderful person.
Reply to this commentLinkReport Abuse"If you wish to help, you will not be stopped. Also, keep your collective helping hands from helping themselves to my collective wallet. Why is this so hard to understand?"
The pacifist could say the same about military spending. He could likewise say if you want to go someplace and fight go ahead you will not be stopped. Gosh, how do we balance all these competing impulses? Perhaps some kind of elected body representing the people?
Why is this so hard to understand?
Reply to this commentLinkReport Abuse@RofC - Helping an injured person on the street has nothing to do with this debate. The question is about the role of the federal govt. You apparently take kindly to the other Bush doctrine of "if somebody hurts, government must act".
Morality has a place in this debate, but let's not conflate it to the level where the US taxpayer must forcibly pay for anyone suffering from anything anywhere.
And besides, Derb makes the sound counter-argument about this kind of liberalism's immoral side -- eg the trap of dependency, propagating fraud, promoting beaurocracy above the mission.
Reply to this commentLinkReport AbuseRight of Center wrote:
"The pacifist could say the same about military spending. He could likewise say if you want to go someplace and fight go ahead you will not be stopped. Gosh, how do we balance all these competing impulses? Perhaps some kind of elected body representing the people?
Why is this so hard to understand?"
Perhaps because expending taxpayer's monies on national defense is constitutional and setting up an international AIDS welfare agency with taxpayer dollars is not?
Reply to this commentLinkReport AbuseRight of Center, your name is rather inapt.
"Are we not morally compelled to act when we can and are able?"
By that logic, foreign aid should be into the trillions of dollars. Some American somewhere has a new flat-screen TV, while some African is starving. We'd better tax that selfish person into oblivion and have the government spread the wealth around the globe!
Your "we have an elected body" hand-wave is weak. We're talking about morality and "ought". What ought the elected representatives do with public funds? The pacifist disagrees with war spending and makes a case against it. And in this case, Derb and others are making a case against PERFAR, largely based on the morality of taking from the public for a given charitable cause amongst an unending array of noble causes.
While you're at it, try not to mangle the pacifist position. I have yet to see a pacifist advocate for "private" military action.
Reply to this commentLinkReport Abuse"Gosh, how do we balance all these competing impulses? Perhaps some kind of elected body representing the people?"
So, every decision made by Congress and the executive branch is OK by you?
Not to put words in his mouth, but Derb's overarching point (which he has made elsewhere many times) is that "compassionate conservatism" is not much better than the liberal nanny state - using our money, forcibly taken through taxation, to give handouts that the private sector can, and probably should, be doing. Morally, we - as individuals - are compelled to help our fellow man, but are free to choose not to do so.
Reply to this commentLinkReport AbuseKeeping AIDS-infected people out of this country puts us on a slippery slope to an unthinkably hellish future in which we actually control our borders!
Next you'll want to keep out perfectly healthy Latinos, or something...
Reply to this commentLinkReport AbuseHear, hear, Derb!
Another point that you could have made but didn't: this is part-and-parcel of the whole disaster of Bushian "Compassionate Conservativism". This was a hugely harmful idea that threatens the survival of the country by turning the whole GOP into "me-too" Democrats. The business of the government is not to forcibly extract charity at gunpoint. (Now that I think of it, Bush did even worse. He cut taxes and then raised spending, meaning that all the charity that he got his jollies from distributing to the Africans will actually be extracted from our CHILDREN at gunpoint.)
GWB was a disaster. The fact that BHO is a bigger disaster doesn't suddenly make GWB any better.
Reply to this commentLinkReport AbuseDerb, your assertion that we should leave global infectious disease control to the WHO - that is, the UNITED NATIONS - is laughable. These people did not bring us smallpox eradication - that was a massive effort by many, many countries, funded almost entirely by the U.S., that actually put boots on the ground in every affected area. The current WHO has no budget for doing anything tangible in any country, a fact they constantly carp about and demand the U.S. rectify. But they seem to have plenty of time to suppress studies showing no harm from second-hand smoke, calling obesity a global epidemic requiring food policing, promoting the purchase (by the U.S. in the realm of billions) of obsolete, untested and unapproved drugs, and enforcing a ban on DDT that leads to the needless slaughter of about a million children every year from the utterly eradicable malaria.
Further, your suggestion that the key to keeping out infectious diseases is simply to ban visas from affected areas is ludicrous. The most well-traveled people in the world are AMERICANS. Should we ban them from re-entry?
Now, all that is not to deny your main point that state "charity" is an oxymoron, with which I heartily agree. But after the initial announcement by Pres. Bush that we would spend 15B on AIDS back in 2003 (no comment), you have to remember that the Dems immediately went on a feeding frenzy. The question then became whether we would spend that money on their priorities of condoms and needle distribution and gender justice and other nonsense or if we would spend it on something the American people wouldn't find vile and would actually save a life or two - that is, life-saving medicine for people with HIV. Conceding your point that all this is state "charity," an oxymoron, the design of the program by Congressional Republicans to divert more money to drugs than condoms was an attempt to try to prevent the usual outrage that foreign aid becomes.
Reply to this commentLinkReport Abuse"Are we not morally compelled to act when we can and are able?"
"We" in this case meaning the US Federal government. The answer is "No". It is not the federal governments role to save every falling sparrow within our borders, let alone outside them. But if you as an individual want to act you are free to do so.
Reply to this commentLinkReport AbuseI thought for sure that Derb's Sub-Saharan terrorist link was going to show Mandela.
Reply to this commentLinkReport Abuse"So, every decision made by Congress and the executive branch is OK by you?"
No, of course not. But the idea that such Congressional action is somehow beyond the scope of the Constitution or constitutes "theft" is absurd.
Reply to this commentLinkReport AbuseI don't think Derb dodges the morality issue; I think he believes that such aid is immoral in the sense that it actually does more harm than good.
Is it not possible, that by providing medical support to those with AIDS, that we are actually, albeit indirectly, helping to spread the disease, as those who are kept alive and relatively symptom-free by AIDS medications are likely to continue to spread the disease? I know that sounds like a cold calculation, but I don't find the above proposition inconceivable.
In general, foreign aid is a waste. If foreign aid were effective, Africa would be one of the wealthiest places on Earth.
Also, the morality issue is more complicated than many make it out to be. It's not simply a matter of helping someone in need. Helping one person in need may preclude us from helping others. For example, I could save the extra money I make for my son's college fund, or I can give it to a charity that pays for poor people to attend college, but I cannot do both with the same money (although, I can go half and half but that might result in not enough money to pay my son's tuition). Which is more moral?
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