David Rieff takes on Hillary’s “new approach” to global health

In a blog post for The New Republic, author David Rieff calls Hillary Clinton’s approach to development naïve, contradictory, and muddled. His post is a response to Clinton’s speech, delivered last week at SAIS, about the administration’s six-year, $63 billion Global Health Initiative. Rieff’s critique rests on three main arguments, all of which will be familiar to Aid Watch readers.

1) Insisting that development is going to be “elevated” to the level of diplomacy and defense won’t make it so. Better to follow the money and see where the real priorities lie:

The secretary was already on record as claiming that the initiative would be a “crucial component of American foreign policy and a signature element of smart power.” On its face, this seems highly unlikely. Anyone doubting this should ponder the fact that one military program, the F-35 Joint Strike Fighter—a weapons platform that no one claims is needed for the counter-insurgency operations that are currently at the core of the U.S. military’s requirements—is on course to cost $325 billion, and may well go higher....In other words, Washington is going to spend on a ‘signature element’ of its smart power less than one-fifth of what it is already committed to spending on something that even the Pentagon does not claim is a signature element of our hard power. No, money may not be everything, but 'follow the money' remains the best advice for understanding what the priorities of the American government really are, as she has claimed before.

2) The bureaucratic structure of the initiative verges on the absurd, fails to make any one agency responsible for success or accountable for failure, and seems almost designed for a meltdown:

[I]n either designing or at least signing off on a program which grants authority for day to day running of the program to three separate agencies (USAID, the Centers for Disease Control, and PEPFAR, the Bush-era President’s Emergency Plan for Aids Relief), each with their own institutional interests, while calling on the resources and expertise of the National Institutes of Health, the Peace Corps, not to mention the departments of Defense and of Health and Human Services (“among others,” as Secretary Clinton said, without irony, in her speech), all reporting to Deputy Secretary Lew, the administration has laid the groundwork for a bureaucratic calamity.

[We would add to this only that Jack Lew, the designated leader of this crew, is leaving his post, no word yet on his replacement, which could take months.]

3) Politicians who assert, as Clinton does here, that health aid can be used as a public diplomacy tool to win the hearts and minds of America’s reluctant allies are basing this view on too little evidence and simplistic assumptions about how aid recipients come to their perceptions of the US:

A far graver mystification is Secretary Clinton’s claim that investments in global health are an important tool of public diplomacy....

…[I]f the secretary really is suggesting that that recipients of foreign aid in very poor countries are so childlike that they view these contributions as dispositive about the nature of America’s values and intentions, then however unintentionally, she is speaking of these adults as if they were children.

But perhaps this hyper-conceited, hyper-complacent conviction of America’s good intention is so internalized in U.S. policymakers—even in one as intelligent as Secretary Clinton—that they are incapable of thinking clearly about how U.S. foreign aid, whether for emergency relief, health, or long-term development, is received by its beneficiaries.

Rieff’s whole, incendiary piece is worth reading in full.