The AIDS Blockade

Tuesday, July 1, 2008

NOT LONG AGO, Sen. Tom Coburn (R-Okla.) was holding up a Senate vote on the President's Emergency Plan for AIDS Relief (PEPFAR), a life-saving program that enjoys wide bipartisan support on Capitol Hill and that President Bush justly regards as one of his brightest achievements. Mr. Coburn and six fellow Republicans were upset that a proposed five-year extension of the program did not require that 55 percent of PEPFAR money go to treating people with HIV-AIDS -- as opposed to being spent to prevent new infections and for other purposes. Mr. Coburn's objection sounds reasonable, except that expert reviews of the program have determined that it is more efficient to let PEPFAR country teams spend the money according to actual need rather than blindly adhering to a congressional earmark. After negotiations with Democrats, Mr. Coburn compromised: At least half of U.S. bilateral aid must go to medical care, but care is defined expansively. He has dropped his objections to moving the bill.

That seemed to put the bill on track for swift Senate passage, until Friday morning, when it turned out that some of Mr. Coburn's original band, led by Sen. Jim DeMint of South Carolina, were still blocking unanimous consent to let the bill proceed. Mr. DeMint voted for PEPFAR in 2003 but thinks the cost of the reauthorization bill, $50 billion over five years, is too high. It is indeed a vast expansion over the $15 billion spent so far, and over the $30 billion that Mr. Bush requested. But part of the increase is attributable to the addition of $13 billion to fight malaria and tuberculosis; anyway, this is not a case of throwing good money after bad. To the contrary, PEPFAR has supported HIV testing and counseling for more than 33 million people and care for more than 6.6 million (including more than 2.7 million orphans and other children infected with and affected by HIV) since 2003. Increasing it would beef up one of the wisest investments the United States has ever made -- in humanitarian terms and in terms of our nation's image abroad.

The question now is how to deal with the holdouts, who -- it bears repeating -- are preventing the Senate from even voting on a measure that a bipartisan majority would approve if given the chance. With Congress on its Fourth of July break and with little time left to deal with housing, counterterrorism surveillance and other issues before the August recess, Majority Leader Harry M. Reid (D-Nev.) had hoped the Senate would debate a limited number of amendments and vote on PEPFAR within a day. That won't happen unless someone gets Mr. DeMint and company to change their minds. Given the Democrats' flexibility with Mr. Coburn, it is up to the Senate Republican leadership and, especially, the White House, to take the lead. If they fail, however, Mr. Reid simply must find the time to pass PEPFAR, even if it means a longer process than he and his colleagues would like. If the price of saving lives is a few lost vacation days for Congress, we say: Pay it.

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