TCS Daily

From Here to the Great Society

By James Pinkerton - November 21, 2003 12:00 AM

Let's stipulate that fighting AIDS -- which has killed 28 million people and infected 42 million more worldwide -- is a noble goal. And let's note that poor countries are most at risk and most in need. And so let's applaud the many billions of dollars that governments, foundations, and corporations are spending to fight AIDS. Yet sadly, let's also concede that the most important variable, which is, of course, the effectiveness of the anti-AIDS war, is going to be hard to measure accurately for a long time to come. In other words, we know the inputs we're allocating right now, but we won't know the outputs for some time.


That reality-disconnect came clear to me as I attended a day-long program on Botswana's place in the global AIDS war, convened by the Center for Strategic and International Studies, held November 12 at the Hart Senate Office Building on Capitol Hill. The session was spearheaded by Senate Majority Leader Bill Frist; he brought all the right people there, all saying the right things. But as I kept listening, I kept adding to my list of possible problems to worry about. Moreover, I thought back to an earlier time in US history, to the Great Society '60s, when good-hearted people with good-sized bankrolls set about doing good. Those four-decades-ago do-gooders accomplished much, but they also failed hugely. And so maybe a look back to that era of domestic crusading can provide some constructive guidance for today's anti-AIDS-ing. After all, lots of lives, lots of money -- and maybe the future direction of US health care, too -- are at stake.


Multilateral Everything


We can begin with a comment on the President of Botswana, Festus Mogae. He seems like a level-headed fellow, leading a prosperous country, blessed with stable politics and a friendly climate for foreign investment. Yet at the same time, AIDS is ravaging his country; more than a third of 15-49 age group is infected, he said. In a country of just 1.5 million, there are at least 42,000 orphans.


Ignoring the dueling political correctnesses of both the puritan right and the promiscuous left, Mogae declared that AIDS prevention in his country rested on "promoting abstinence, faithfulness to partners as well as use of condoms." In other words, anything that cuts down on unsafe sex is a good idea, period, full stop. Bravo. That pragmatic and eclectic view has helped make Botswana the grand central station of international AIDS-fighting efforts; Merck, for example, has donated $50 million. So has the Bill and Melinda Gates foundation. Other lesser players include Pfizer, Bristol Myers Squibb, Baylor College of Medicine, and the Harvard AIDS Institute.


But of course, the presence of so many players inevitably raises concerns about coordination, duplication, and destructive competition; those issues consumed much of the day's presentations. However, I can't say for sure that what I heard put my mind entirely at ease.


Consider, for example, the presentation of Helene Gayle, the director of the HIV, TB and Reproductive Health Program at the Gates Foundation. She looked good, meant well, and spoke articulately -- but after she finished speaking, I'm not entirely sure I understood what she had said. Her theme was that the keys to success were "partnerships." OK. But her explanation of those partnerships was a whirlwind of buzzwords, a swirl of "empowerment" and "communities" and "multilateral" -- multilateral what? Multilateral everything. I don't mean to make fun, because Gayle obviously meant well. And it's difficult, one must acknowledge, for a bunch of people sitting in a plush government office building to communicate how their good words and good works will trickle down through the system, all the way over to Africa, to a baby wasting away of AIDS. So the proof will be in the pudding. But I do know this much for sure: Gayle has already overseen the giving away of $1.2 billion of Gates' money. Let's trust that it's being well spent.


Gayle then introduced Randall Tobias, named by President Bush in July to be the US Global AIDS Coordinator. He's the former CEO of Eli Lilly. Retired from that big job since 1999, he obviously doesn't need to work anymore, but he's putting himself out there, trying to make a difference, trying to alleviate a horrible fate for millions living -- and dying horribly -- in 14 African and Caribbean countries.


Tobias began by quipping that if he simply declared that he, too, was for public-private partnerships, "I could save a lot of time." But he was there to say more; his goal, he said, was to eliminate seven million infections, get two million people under treatment by the end of five years, and provide care for 10 million more people. He believed he could do this, he added, because "This is a moment in time when the sun and the moon and the stars have all come into alignment." That is, the US government, the United Nations, the World Bank, and a good chunk of the medical-science establishment have all joined together in -- yup, you guessed it -- a "public-private partnership." Indeed, companies from Tobias' previous life, the Big Pharma, have "partnered" up big-time -- some $2 billion in out-of-pocket expenditures in the last five years.


So as Tobias talked enthusiastically about "the public sector, the private sector, community groups, all coming together... all attacking the same problem... all serving the same people," I found myself feeling warm inside, as I thought of how satisfying it is to be part of Something Big, something Good. Maybe this is the way folks felt during World War II, I speculated -- everyone cheerfully sacrificing something, everyone doing his or her part.


This all-in-it-together-no-questions-asked approach worked during Second World II, but did it work in other wars that are perhaps more immediately analogous, such as the War on Poverty? That's when it hit me: I've heard about -- and read about -- all this before.


Been Here, Done This?


In the '60s, the best and brightest of American social-policy making all converged around the idea of putting an end to want. They had read Michael Harrington's The Other America, published in 1962, and were determined to do something -- something bold, something decisive -- about the deplorable conditions that Harrington had chronicled. And yet for all their energy and ambition, these pioneering Great Societeers were hopelessly naïve, even incompetent. As a result, many of the billions they spent -- in non-inflated 60s dollars -- were not only wasted, but did actual harm.


That harsh assessment comes from one of the most important books written about social-policy making during those years, Nicholas Lemann's The Promised Land: The Great Black Migration and How It Changed America, published in 1991.

Lemann focuses on Robert F. Kennedy, who was not only First Brother in the early '60s, but also JFK's attorney general. Thus RFK was perfectly positioned to take the lead role in Kennedy administration planning. Lemann, by the way, was and is no conservative -- after a long career in magazine journalism, including at The New Yorker, he is now the dean of the
Columbia Journalism School -- but nonetheless he paints an unflattering portrait of RFK. In his telling, Kennedy was a man of ordinary intelligence, at best. But he did have a vision, of sorts; he saw the world as "a battle between good and evil." And he could further see that fighting poverty would "instantly put him in the vanguard of a great cause." Surely such vanguarding was not only morally satisfying, but also politically empowering.


But of course, this long-ago version of "moral clarity" was not a guide for effective action. Somebody had to think of what, actually, to do -- what to spend money on. In the early '60s, Washington's social welfare policymaking apparatus was dominated by aging New Dealers -- "entrenched civil service lifers," in Lemann's curt phrasing. When the Kennedy folks stirred around the government looking for ideas, Lemann recalls, "every agency had a long list of programs that hadn't quite made the cut for the New Deal." These were offered up the chain of command "with the proviso that only the agency suggesting the program was competent to run it." And so it was that the Department of Labor wanted jobs programs, the old Department of Health, Education and Welfare wanted education and welfare programs, and Agriculture wanted food and farm programs. As they say in Washington, where you stand depends on where you sit.


But the Kennedy people were determined to do things differently. After all, they had lots of big ideas in other areas as well; JFK, for example, was convinced he could win the Vietnam War using nimble Special Forces, completely unlike the hulking Army units that his presidential predecessor, Dwight Eisenhower, had once used to beat Hitler. So if unconventional James Bond-types could beat communism, why couldn't something equally cool be used to beat poverty? Finally, the Kennedyites found what they were looking for; Lemann calls it "the public-policy equivalent of the cavalry riding to their rescue." And what was this Next New Thing? It was called "community action."


Community Action


Community action, Lemann recorded three decades later, involved "three key elements." First, "It would operate at the ground level; community action agencies would be located in poor neighborhoods, not downtown office buildings." Second, "It would coordinate a wide variety of social services in a single location, so that poor people wouldn't have to spend half their lives shuttling between the welfare office and the public housing office and the job placement office." Third, "It would plan its activities based on what poor people actually wanted from government, rather than what bureaucrats in Washington thought they needed."


As Lemann remembers, "Community action had the excitement of a new idea; it seemed fresh and vigorous, and lent a groundbreaking spirit to the creaking antipoverty effort." Indeed, it helped the gung-ho, get-the-country-moving-again Kennedyites by providing them with a rationale to do what they wanted to do anyway, which was to "bypass the old-line departments and start an adventurous new government agency." As one veteran of those days recalled, "I was an arrogant smart-assed economist, disdainful of the bureaucracy."


Two points here: First, one should indeed, as a general rule, be disdainful, or at least skeptical, of bureaucracy. Second, yet to the extent that bureaucracies represent professionalism and probity, they have a great value that should not be lost in the transition. In other words, one needn't be hostile to bureaucrats as human beings -- although by definition, an existing bureaucracy, created in the past, is behind the times. And the faster the times change, the more behind the bureaucracy falls. So shaking up a bureaucracy is always a good idea -- if the person doing the shaking knows what he or she is doing, and if the basic commitment to fair play and transparency is not lost.


So what happened in the '60s? The bureaucracy was shaken up, but the results weren't an evolution upward; they were a sharp devolution downward. After Kennedy's assassination, the trend toward anti-bureaucratic radicalism accelerated. The concept of the Community Action Agency (CAA) as the model -- non-bureaucratic, but government-funded -- was enshrined by the Office of Economic Opportunity (OEO), which was signed into law by President Lyndon Johnson in 1964. OEO in turn funded CAAs across the country. This pell-mell de-bureaucratization unleashed results, but the results were chaos and corruption. CAAs not only feathered the nests of their chieftains; they also funded insurgent political candidates, even radical-chic revolutionaries. In Chicago and Oakland, the Black Panther Party received CAA grants. In Mississippi, CAAs agitated for plantation-breaking-up "land reform." And so a generation of Jesse Jackson-types made their bones and wetted their whistles, mostly while on Uncle Sam's payroll. These street-activists-turned-grantees -- whom New York City Mayor Ed Koch would deride as "poverty pimps" -- had a strong ideological wind at their back. Not coincidentally, urban ferment turned into unrest, and unrest turned into riots. In the '60s and into the '70s, lefties worldwide looked with admiration to Chairman Mao's "cultural revolution." From afar, it seemed as though Mao was using youth to shake up the bureaucracy; only later was it learned that millions were being killed.


Fortunately, a backlash against all this riotous radicalism set in; the Democrats were defeated in the 1968 election, and the Great Society cultural revolutionaries were removed from top jobs in Washington by the incoming Nixon administration. Interestingly, the newly hired Republicans at OEO included a young Don Rumsfeld to run the place, as well as an even younger Dick Cheney to help him. Under Republican leadership, OEO was mostly de-radicalized; it was renamed the Community Services Administration, and its functions eventually fell back into the traditional bureaucracy.


However, the notion of the CAA survived, not only in Washington, but around the country and around the world. Today, the new name for the Community Action Agency of old is "Non-Governmental Organization," or NGO. Like their ancestors, the CAAs, the NGOs of today can do just about anything they want, as long as they can find somebody to fund them.


So that's the sad saga of the Great Society, during which bureaucrats were replaced with mutant public-sector entrepreneurs, who oftentimes proved to be even less reliable, less accountable, and less effective than their civil-serviced predecessors. So what do we have to look forward to now? We'll look at that tomorrow.



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