Wednesday, August 31, 2005

Who's Paying for Our Patriotism?

The writer is James Madison professor of political economy at Princeton
University. This article appeared in the Washington Post.

By Uwe E. Reinhardt

President Bush assures us that the ongoing twin wars in Iraq and Afghanistan are worth the sacrifices they entail. Editorialists around the nation agree and say that a steadfast American public was willing to stay the course.

Should anyone be surprised by this national resolve, given that these wars visit
no sacrifice of any sort -- neither blood nor angst nor taxes -- on well over 95
percent of the American people?

At most, 500,000 American troops are at risk of being deployed to these war
theaters at some time. Assume that for each of them some 20 members of the wider family sweat with fear when they hear that a helicopter crashed in Afghanistan or that X number of soldiers or Marines were killed or seriously wounded in Iraq. It implies that no more than 10 million Americans have any real emotional connection to these wars.

The administration and Congress have gone to extraordinary lengths to insulate voters from the money cost of the wars -- to the point even of excluding outlays for them from the regular budget process. Furthermore, they have financed the wars not with taxes but by borrowing abroad.

The strategic shielding of most voters from any emotional or financial sacrifice
for these wars cannot but trigger the analogue of what is called "moral hazard"
in the context of health insurance, a field in which I've done a lot of scholarly work. There, moral hazard refers to the tendency of well-insured patients to use health care with complete indifference to the cost they visit on others. It has prompted President Bush to advocate health insurance with very high deductibles. But if all but a handful of Americans are completely insulated
against the emotional -- and financial -- cost of war, is it not natural to
suspect moral hazard will be at work in that context as well?

A policymaking elite whose families and purses are shielded from the sacrifices war entails may rush into it hastily and ill prepared, as surely was the case of the Iraq war. Moral hazard in this context can explain why a nation that once built a Liberty Ship every two weeks and thousands of newly designed airplanes in the span of a few years now takes years merely to properly arm and armor its troops with conventional equipment. Moral hazard can explain why, in wartime, the TV anchors on the morning and evening shows barely make time to report on the wars, lest the reports displace the silly banter with which they seek to humor their viewers. Do they ever wonder how military families with loved ones in the fray might feel after hearing ever so briefly of mayhem in Iraq or Afghanistan?

Moral hazard also can explain why the general public is so noticeably indifferent to the plight of our troops and their families. To be sure, we paste cheap magnetic ribbons on our cars to proclaim our support for the troops. But at the same time, we allow families of reservists and National Guard members to slide into deep financial distress as their loved ones stand tall for us on lethal battlefields and the family is deprived of these troops' typically higher civilian salaries. We offer a pittance in disability pay to seriously wounded soldiers who have not served the full 20 years that entitles them to a regular pension. And our legislative representatives make a disgraceful spectacle of themselves bickering over a mere $1 billion or so in added health care spending by the Department of Veterans Affairs -- in a nation with a $13 trillion economy!

Last year kind-hearted folks in New Jersey collected $12,000 at a pancake feed to help stock pantries for financially hard-pressed families of the National Guard. Food pantries for American military families? The state of Illinois now allows taxpayers to donate their tax refunds to such families. For the entire year 2004, slightly more than $400,000 was collected in this way, or 3 cents per capita. It is the equivalent of about 100,000 cups of Starbucks coffee. With a similar program Rhode Island collected about 1 cent per capita. Is this what we mean by "supporting our troops"?

When our son, then a recent Princeton graduate, decided to join the Marine Corps in 2001, I advised him thus: "Do what you must, but be advised that, flourishing rhetoric notwithstanding, this nation will never truly honor your service, and it will condemn you to the bottom of the economic scrap heap should you ever get seriously wounded." The intervening years have not changed my views; they have reaffirmed them.

Unlike the editors of the nation's newspapers, I am not at all impressed by people who resolve to have others stay the course in Iraq and in Afghanistan. At zero sacrifice, who would not have that resolve?

Condoms Lose Ground in HIV Prevention

By William Fisher

Central America and Uganda this week became the latest targets for right-wing leaders to blast HIV/AIDS prevention efforts that stray from the George W. Bush administration's "abstinence-only" ideology.

One of the country's most influential faith-based organisations, Focus on the Family (FOF), charged that a U.S. not-for-profit group, Advocates for Youth, "is asking its members and supporters to contact key Ugandan health and government officials and urge them to more fully embrace condoms and other forms of birth control".

FOF quoted the Advocates for Youth website, which says, "There is no evidence that abstinence-only-until-marriage programmes work," adding that support must be given to "science-based HIV prevention strategies" rather than "ineffective abstinence-only-until-marriage programmes."

Peter Brandt, FOF's senior director of government and public policy, said the group is flatly misstating reality in order to promote its condoms-first agenda.

"What the studies bear out is that abstinence works every time in preventing the spread of HIV and all other sexually transmitted diseases," he said. "Condoms aren't a solution to the problem of young people dying; they're a politically correct cause for those on the political left."

Focus on the Family, led by televangelist Rev. James Dobson, claimed that Uganda "once had the highest HIV-infection rates in the world -- 30 percent in some regions. But through the government's strong abstinence policy, rates have plummeted -- from 21.2 percent among pregnant women in 1991 to 6.1 percent in 2001."

It said the general population has also seen a decline to around seven percent. "And that number figures to drop further, since studies show a third of Ugandan college students are keeping their abstinence pledges."

However, many groups say Uganda is now in the midst of a "condom crisis" that is endangering the country's previously successful prevention efforts.

According to the Centre for Health and Gender Equity (CHANGE), condoms have become difficult to find in cities, even for a high price, and are unavailable in many rural areas.

Reports indicate that in some areas, including those with large numbers of internally displaced persons, people desperate to prevent HIV infection have begun using garbage bags as condom substitutes.

Similar trends are underway in a number of other countries, including Zambia, where reduced supplies of condoms and shifts in funding of prevention programmes are leaving millions at risk, and Kenya, Namibia, and Tanzania, where U.S. funding is indirectly supporting the resurgence of fundamentalist religious movements and undermining effective HIV prevention, CHANGE says.

In a related development, right-wing Senator Tom Coburn, an Oklahoma Republican, demanded that the United States stop financing a Central American HIV-AIDS prevention programme, run by Population Services International (PSI), a nonprofit group.

In a letter to Pres. Bush, Coburn -- a medical doctor -- complained about PSI's "Noches Vives" and other programmes. Noches means nights; Vives is a brand of condoms.

Because most prostitutes in poor countries don't show up at local clinics to ask for condoms, PSI sponsors Noches Vives, sending aid workers to bars, brothels and other places where prostitutes congregate. They go from table to table, handing out condoms, sometimes using bananas as props, showing people how to use them.

Coburn wrote that PSI's funding is up for renewal, and PSI has applied for tens of millions more to continue the project, adding, "There is something seriously askew at USAID when the agency's response to a dehumanising and abusive practice that exploits women and young girls is parties and games."

"It's a simple activity for largely illiterate people," said Michael Holscher, regional executive director for PSI. "We can't just stand up in a bar and say, 'AIDS will kill you.' With an interactive activity, we can hold their attention, sometimes for as long as an hour."

Shortly after Coburn's letter, USAID cut off money for the programme.

Rev. Tim Simpson of the newly-formed Christian Alliance, told IPS, "This is an absolutely tragic situation that is being compounded by the extremist ethics of Christian fundamentalists, who place sexual purity ahead of saving lives."

"The scourge of HIV/AIDS ought not be the occasion for trotting out the right wing's failed attempts at abstinence education," he said. "They don't seem to be nearly as concerned about Africans dying as they are about keeping Africans from having sex outside of marriage."

"But one infected prostitute can destroy the lives of hundreds of people in a very short period of time, so there is no question that the need is acute. It is time that the U.S. government stops listening to groups like Focus on the Family and instead starts focusing on reality," Simpson added.

The Coburn action came on the heels of a lawsuit challenging the government's "anti-prostitution" policy, charging that it is an "unconstitutional infringement of speech" that is undermining international efforts to stem the spread of HIV/AIDS.

The NGO, DKT International, filed the suit in the District Court of the District of Columbia against USAID and its administrator, challenging the requirement that U.S. and foreign NGOs receiving USAID funding from adopt a policy "explicitly opposing prostitution and sex trafficking".

USAID adopted the rule requirement in June, as one of a number of policies advocated by the "pro-life" religious right. Other Bush administration initiatives include endorsement of the so-called Mexico Protocol, which forbids abortion counseling in family planning programmes overseas.

U.S. observance of the protocol -- termed "the global gag rule" by family planning professionals -- was rescinded during the Bill Clinton administration (1992-2000) but reauthorised under Bush on his first day in office in January 2001.

Under the rule, foreign family planning agencies may not receive U.S. funds if, with their own funds, they counsel on or refer for abortion, advocate for more lenient abortion laws in their own country, or provide abortion services.

DKT's president, Philip D. Harvey, said the anti-prostitution and sex trafficking policy "does a grave disservice to international AIDS-prevention programmes and to those who carry them out. The policy does no good, and is clearly doing considerable harm."

DKT International is a non-profit organisation based in Washington. It manages contraceptive social marketing programmes for family planning and AIDS prevention in 11 countries in Africa, Asia, and Latin America. DKT's programmes currently serve just under 10 million couples, with an operating budget of 50 million dollars.

As a result of refusing to adopt (and certify) USAID's policy on prostitution, DKT lost USAID support for its AIDS-prevention work in Vietnam. Its lawsuit seeks injunctive relief to permit it to resume this work.

Meanwhile, in Afghanistan, the anti-abortion Population Research Institute (PRI) is making plans to establish a pro-life office in Kabul "to assist Afghan women and families in their fight against the anti-natal agenda of U.N. agencies and anti-child NGOs".

PRI said, "The recent legalisation of abortion by Kabul's interim government was the catalyst…Abortion in Afghanistan is now legal up to the third month of pregnancy. Although, according to reports, three doctors must certify that the abortion is a medical necessity, such regulations have quickly degenerated in other countries to abortion on demand."