House Republicans want to cut funding for health programs abroad and for community clinics here at home. And although the projected savings are small, at least relative to the size of the federal budget, the philosophical shift they signal is big. This is the end of compassionate conservatism.
You remember compassionate conservatism, don't you? It was George W. Bush’s slogan, going back to the late 1990s, when, as a candidate, he told audiences that “Prosperity without purpose is just materialism” and vowed to “rally the armies of compassion in our communities to fight a very different war against poverty.”
Cynics saw it as empty rhetoric or, worse, a deliberate distraction from policies that were actually quite harsh to the nation’s least fortunate. The cynics had a pretty good point. Bush raided the treasury, in order to give wealthy people huge tax cuts, and the resulting budget crunch has forced all sorts of cuts to vital programs over the years.
Still, Bush never gave up the rhetoric of compassion. And on at least a few occasions he lived up to it. Community clinics were one example: As president, he doubled their funding. According to an account by Kevin Sack in the New York Times, that led to the creation or expansion of more than 1,200 clinics around the country. “This is a really good use of the taxpayers’ money,” Bush said at the time, noting that good primary care helps keep people out of the emergency room.
Bush’s commitment to global health was even stronger. In 2003, he called for a five-year, $15 billion initiative to fight HIV around the world through the President’s Emergency Plan for AIDS Relief (PEPFAR). It was a dramatic effort. Previously, the U.S. had spent less than $1 billion a year on HIV abroad. And it yielded dramatic results. According to official PEPFAR statistics, the program had, by the fall of 2008, provided life-sustaining treatment to more than 2.4 million people and allowed more than 200,000 infants to be born HIV-free.
Both the community clinic and global HIV initiatives came with conservative baggage. Bush promoted the former as an alternative to expansions of government-provided health insurance, rather than as a supplement to it, and he insisted the latter promote abstinence. Even so, Bush went out of his way to praise not just these programs but also the moral imperative behind them, frequently invoking religious imagery.
Listen, for example, to what Bush said during a speech about PEPFAR in 2004:
HIV/AIDS, you see, is a challenge, it's a direct challenge to the compassion of our country, and to the welfare of not only our nation, but nations all across the globe. It's really one of the great challenges of our time. This disease leaves suffering and orphans and fear wherever it reaches…
Every day in our world, 8,000 lives are lost to the AIDS pandemic -- 8,000 people a day. … when they get the antiretroviral drug, there's a Lazarus effect -- (applause) -- and people, all of a sudden, say, I have hope. And when others have hope -- when someone has hope, that spreads to other people. …
Around the world, AIDS remains a source of great suffering. It’s important for our fellow countrymen to remember. And we have an obligation to work to relieve the suffering, and we will.
Maybe those words were utterly sincere. Maybe they weren't. But ask yourself this: When was the last time you heard anything remotely like it from a prominent Republican? Even if compassionate conservatism was mostly hype, it said something about Bush, his allies, and their supporters that they thought the hype was worth creating.
Today, by contrast, Republican leaders are perfectly content to walk away from these programs and many others without so much as acknowledging the consequences, let alone addressing them. Poor people in the U.S. might not be able to get basic medical care? Victims of HIV abroad might lose their life-sustaining drugs? If Republicans have paused even a moment to think about these things, they sure haven't shown it.