Tuesday, June 5, 2007

Puerto Rican AIDS a Test for Bush

I don't think that President Bush is the type to be terribly concerned about "legacy" issues coming in to the end of his term, but I do think he feels the same as always about what he sees as his political duty to the GOP. So this week we have rollouts of Bush proposals to 1) at least start to develop a national emissions policy for the US (something that would be years along if Gore had won in 2000) and 2) increase US funding for AIDS programs in Africa to $30 billion. This is policy on a grand scale, which is precisely why Bush is able to make it. He will cooperate with the loading of some tens of billions of dollars into the pipeline, and that will be that: what happens to the money downstream years from now is not his responsibility.
There is a faster way, though, to get some money to AIDS patients more or less right away, if the president really wants to put his money where etc., and that would be to improve funding for AIDS patients in the US and Puerto Rico. I mention Puerto Rico, aside from the fact that I live here, not because Puerto Rico has the US's worst rates of infection, as many might believe. Actually Puerto Rico ranks fifth amongst states and US territories in terms of infections per thousand people. Rather Puerto Rico is important because territories and states don't administer this kind of federal money in a consistent way. In the case of Medicaid, spending for Puerto Rico is "capped" (by US Congress) at $240 million. Meanwhile, the "Ryan White Act" money to supplement Medicaid for AIDS patients is a national fund of just $53 million. President Bush could show he was some action and not just all talk if he directed some of his civic-minded money to underfunded AIDS patients who are US citizens.
Unfortunately there is another problem for federal money in Puerto Rico, and that is the traditional Latin American bureaucracy that still exists in Puerto Rico and employs many thousands of government workers. In this old bureaucratic culture, federal money is "the pie," and the actual intentions of federal grants are treated with an attitude that approaches passive resistance. When Federal administrators suggested that the Ryan White Act money might be deposited in its own account, instead of just being emptied into the coffers of the San Juan municipal government, they were rebuffed. Possession, the reasoning goes, in nine tenths of the law. It is no surprise, then, that investigators complain of an excessive degree of both financial irregularities and service inefficiencies, and many AIDS patients are not getting the drugs they need.
Come to think of it, there was a politician in the 1990's who oversaw a program called the Paperwork Reduction Act, which apparently had some success in reducing the number of federal employees. You remember: Vice-President Gore.
(Today's post draws from reporting today in the New York Times.)

No comments: