The Bush Legacy: My View - Part 2

This is Part 2 in a series about the legacy of President George W. Bush as I see it. You can read Part 1 by clicking HERE. It is clear that any discussion of the Bush Legacy will inherently be colored by the political or philosophical views of the author. It is nearly impossible to produce an unbiased view of this, or any President's legacy. And, without the luxury of time to reflect back on what kind of place our nation and our world have become as a result of his policies, we can only attempt to suggest what history might say about him. Let us then consider some facts as we know them...

Compassionate Conservatism
George W. Bush ran his 2000 presidential election as a "compassionate conservative". It was a label which many assumed was merely a slogan intended to make him sound more moderate and acceptable to Democrats. The phrase was widely attacked by those on the Left as well as those the Right. Many on the Left thought the phrase to be vacuous or contradictory. Many on the Right were offended by the term, believing that Bush was trying to differentiate himself from the "typical" conservative who therefore must be "heartless".


Compassionate Conservative Cartoon - 1999.
At first, the term "compassionate conservative" was thought to be something new which George W. Bush had invented himself, but the phrase had already been used to describe his father, then-Vice President George H.W. Bush, in 1986. The term was probably originated by historian and presidential advisor Doug Wead in 1977. In 1979, Wead gave a popular speech entitled “The Compassionate Conservative” at the annual Washington Charity Dinner. Wead contended that the policies of Republican conservatives should be motivated by compassion, not protecting the status quo. Wead declared himself to be “a bleeding heart conservative,” meaning that he cared for people and sincerely believed that a free marketplace was better for the poor.

Marvin Olasky

As defined by Dr. Marvin Olasky, "compassionate conservatism" is the outreach of conservatives to help poor people turn to self-reliance as a means for improving themselves. In his 1992 book, 'The Tragedy of American Compassion', Olasky argued that private individuals and organizations, particularly the Christian church, have a responsibility to care for the poor, and he contended that the challenging, personal, and spiritual help of Christians, common until the 1930s, was more effective than the government welfare programs of recent decades. In 1994, his book gained the endorsement of William Bennett and Newt Gingrich, who gave a copy to every incoming Republican freshman representative in the 1994 Congress.

In 2000, Olasky wrote another book entitled 'Compassionate Conservatism: What it is, What it Does, and How it Can Transform America'. Interestingly enough, George W. Bush wrote the introduction. Author Michelle Goldberg says that Olasky was an advisor to Bush’s first Presidential campaign, and influenced not only the thinking of Bush, but the thinking of the Republican Party as well -- a reference no doubt, to Newt Gingrich and others who read his works. Myron Magnet described "compassionate conservatives" this way in a Wall Steet Journal article...

Compassionate conservatives [...] offer a new way of thinking about the poor. They know that telling the poor that they are mere passive victims, whether of racism or of vast economic forces, is not only false but also destructive, paralyzing the poor with thoughts of their own helplessness and inadequacy. The poor need the larger society's moral support; they need to hear the message of personal responsibility and self-reliance, the optimistic assurance that if they try -- as they must -- they will make it. They need to know, too, that they can't blame "the system" for their own wrongdoing.

--Myron Magnet, What Is Compassionate Conservatism?, 5 February 1999

George W. Bush seemed to echo such sentiments in his use of the term "compassionate conservative". As quoted in an article at the Hoover Institution, Bush said...

Government cannot solve every problem, but it can encourage people and communities to help themselves and to help one another. Often the truest kind of compassion is to help citizens build lives of their own. I call my philosophy and approach “compassionate conservatism.” It is compassionate to actively help our fellow citizens in need. It is conservative to insist on responsibility and on results. And with this hopeful approach, we can make a real difference in people's lives.

-—President George W. Bush, April 2002

From this statement then, we can conclude that George W. Bush did not believe that government was the answer to every problem. Nevertheless, he must have imagined that some problems can be tackled best or only by the government. He was not averse to having the government help "our fellow citizens in need", so long as there was an emphasis on "responsibility" and "results". Bush clearly felt that conservatism and compassion are not mutually exclusive. In fact it seems, he believed that when implemented correctly, the effects of conservatism are by their very nature a form of "compassion". Another statement from candidate Bush in the Hoover article mentioned above, reinforces this...

I am convinced a conservative philosophy is a compassionate philosophy that frees individuals to achieve their highest potential. It is conservative to cut taxes and compassionate to give people more money to spend. It is conservative to insist upon local control of schools and high standards and results; it is compassionate to make sure every child learns to read and no one is left behind. It is conservative to reform the welfare system by insisting on work; it’s compassionate to free people from dependency on government.

--Presidential Candidate George W. Bush, 2000

Bush with 'Compassion In Action' banner.
Thus, "compassionate conservatism" was a foundational principle for President Bush. It provided the structural framework around which his domestic policies and programs would be developed. It also affected his foreign aid programs in a very positive way, as we shall soon see. George W. Bush sought "to actively help our fellow citizens in need", but he didn't merely want to throw money at a problem -- a bad habit for many politicians -- President Bush wanted to get "results". He truly wanted to help people and to make a difference in their lives.

Bush felt that one way to accomplish this was to have greater involvement from non-governmental entities such as faith-based organizations. From personal experience, he knew that the power of faith can transform lives. He also knew from Dr. Olasky's books, and perhaps from experience as well, that faith-based programs can be more effective than governmental programs. And when he thought it was necessary to use legislation for addressing a particular issue, he demanded "responsibility", "accountability" and "results".

Faith-Based Initiatives
The White House Office of Faith-Based and Community Initiatives (OFBCI) was an office within the Executive Office of the President of the United States. OFBCI was established by President George W. Bush through an executive order on January 29th, 2001. It represented one of the key domestic policies of the Bush campaign promise for "compassionate conservatism." The initiative sought to strengthen faith-based and community organizations and to expand their capacity to provide federally-funded social services, with the idea that these groups are better-situated to meet the needs of local individuals.

As Texas governor, George W. Bush had used the "Charitable Choice" provisions of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) to support faith-based groups in Texas. PRWORA (otherwise known as "welfare reform", or "workfare") allowed "faith-based" entities to compete for government contracts to deliver social services. He wanted to do the same at the federal level.

For fiscal year 2005, more than $2.2 billion in competitive social service grants were awarded to faith-based organizations (FBOs). Between fiscal years 2003 and 2005, the total dollar amount of all grants awarded to FBOs increased by 21 percent (GAO 2006:43). The majority of these grants were distributed through state agencies to local organizations in the form of formula grants (GAO 2006:17).


OFBCI National Conference - June 2008.
Critics of the OFBCI, including Americans United for Separation of Church and State and the American Civil Liberties Union (ACLU), alleged that it violated the Establishment Clause by using tax money to fund religion. But the White House established certain restrictions on FBOs that accepted government funding to protect the separation of church and state.

They may not use direct government funds to support inherently religious activities such as prayer, worship, religious instruction, or proselytization. Any inherently religious activities that the organizations may offer must be offered separately in time or location from services that receive federal assistance. FBOs cannot discriminate on the basis of religion when providing services (GAO 2006:13).

Critics also questioned whether FBOs were more "successful" or "efficient" than government agencies at delivering services. However, some preliminary studies suggested that they might be. For example, a 2002 study of interim housing programs in Michigan found that FBOs were more likely to focus on values, treat their clients in a more comprehensive manner, and be perceived by their clients as more caring. Terms such as "loving", "nurturing", and "helping" were used to describe caseworkers in programs which scored high in faith integration. According to the study...

One of our most important findings is that there is no standard approach to service delivery that characterizes all FBOs... there are significant differences among FBOs. There are also significant differences between the FBOs, whether publicly or privately funded, and the one government agency in our study:

Clients perceive frontline workers at most, if not all, faith-based organizations as more caring than those who work for the government agency. As it turns out, what appears to make the greatest difference in the lives of the homeless are the qualities of the tenant managers, case managers, and on-site counselors who interact with clients on a day-to-day basis, regardless of the setting. Whether clients perceive frontline workers as caring, empathetic people or simply as enforcers of rules and regulations with an unsympathetic ear makes the crucial difference [emphasis added].

--How Faith-Based and Secular Organizations Tackle Housing for the Homeless, October 2002

Faith-based contractors involved in a New York City Charitable Choice Demonstration Program designed to help individuals who had lost their welfare benefits because of compliance problems, had a difficult time making contact with the majority of the targeted group -- many of whom had moved or were living in shelters after losing their welfare benefits. But once a client was reached, the success rate among the FBOs was, on average, half-again higher than anticipated, while certain individual FBO programs scored two and one-half times better than expected.

In December 2004, a benchmarking report suggested that faith-based nursing home care was superior to that of non-FBOs...

For nursing homes, CMS [the Centers for Medicare and Medicaid Services of the Federal Department of Health and Human Services] provides data related to resident characteristics and for deficiencies discovered during inspections and from complaints. We found that:

Regarding data from nursing home inspections, church-related nursing homes had, on average, fewer deficiencies (e.g., nutrition and diet deficiencies) than the average for all other types of nursing homes. On average, church-related nursing homes had 25 percent fewer inspection deficiencies than all other types of nursing homes. Findings related to complaints followed the same pattern as for inspection deficiencies. Church-related nursing homes had, on average, fewer complaint deficiencies than the average for all other types of nursing homes combined – on average, 57 percent fewer complaint deficiencies than all other nursing homes. Church-related nursing homes also had fewer average inspection and complaint deficiencies than other non-profit nursing homes. The differences between church-related and other non-profit nursing homes were substantially less than the differences between non-profit and other types of nursing homes (which includes both for-profit and government-run nursing homes). Church-related nursing homes had only 6 percent fewer inspection deficiencies than other non-profit nursing homes.

--Using Administrative Data to Compare the Performance of Faith-Affiliated and Other Social Service Providers, December 2004

For more such study results, go HERE.


Bush with Katrina response FBO volunteers.
Faith-based organizations also got high marks for their response to Hurricane Katrina. In February 2006, a White House report praised faith-based organizations for their response to the devastation, and it noted that their successes came largely "in spite of, not because of, the government." The report -- The Federal Response to Hurricane Katrina: Lessons Learned -- included a call for better integration of faith-based groups in future emergency planning operations. Among its recommendations was the designation of a specific office within the Department of Homeland Security as a point of contact for such organizations. In recognizing the important role they played, the report found that better leveraging of the work of faith-based groups would allow government to more effectively concentrate its energies and resources.


Southern Baptists serve meals after Katrina.
In a section entitled "What Went Right," the report lauded the recovery efforts of faith-based organizations and noted several examples of the services these groups provided and continued for some time to deliver. Among them:

The efforts of some 6,000 Southern Baptist Relief volunteers from 36 state conventions were recognized for running mobile kitchens and establishing "pop-up" shelters at churches or other agencies. Operation Blessing was cited for providing food and shelter, transporting supplies, and for making $4 million in grants available to churches and smaller relief groups for recovery efforts. The Salvation Army was highlighted for fielding more than 60,000 health and welfare inquiries and helping to locate 25,508 people nationwide. Christ in Action, based in Manassas, Virginia, was recognized for setting up mobile kitchens in Mississippi and for repairing over 500 houses in time for families to reoccupy them by the end of December.

Jewish volunteers build homes after Katrina.
"These and many other faith-based organizations filled the gaps that other private and public sector organizations could not," the report stated. But the report also conceded that faith-based groups encountered difficulties working with government, which sometimes impeded their relief efforts, according to information collected from briefings with faith-based leaders. To download the entire 217-page White House report in PDF format, click HERE.

On the one-year anniversary of Hurricane Katrina, faith-based organizations were still hard at work. The 'Center on Philanthropy' and 'Corporation for National and Community Service' estimated that $5.3 billion had been donated in private money to Gulf Coast hurricane relief and 500,000 volunteers had donated services. But it was apparent that the year-long effort was beginning to put a strain on the FBOs. "At some point we can't afford it," Desmond Brown, Director of Health and Welfare Policy for Catholic Charities USA, said in a Washington, D.C. speech. He was referring to Katrina relief and reductions in federal aid for general human services. "There will be a point, God forbid, that we will have to say we can't provide you with a hot meal." For more information, go HERE.

Source: Pew Forum Survey

For eight years, the Bush administration sought to open the door wide to funding religious groups that offer social services of all kinds – among them job training, drug treatment, prisoner reentry, and after-school programs. It brought unprecedented visibility to their efforts and boosted the number funded by federal programs.

But the administration also pushed the envelope, funding groups that included religious elements in their social-service programming, a practice the courts have generally rejected. The most controversial issue was whether religious groups should be allowed to hire only people of their own faith as staff in federally funded projects. Some in Congress and other critics insisted that groups should not be allowed to engage in such selective hiring, calling it discrimination. The debate became so intense that Congress never approved specific legislation for the faith-based initiatives, and the Bush administration implemented the program largely through executive orders.

In a last-minute gift to faith-based organizations, the Bush administration in late 2008 issued guidelines for prospective grantees on how to gain exemption from laws that specifically prohibit religious hiring, citing a legal opinion from the Justice Department. “The administration has fought for [FBOs] with every possible tool at its disposal,” said Ira Lupu, a legal expert on the [faith-based] initiative, in a December 2nd, 2008 session of the Roundtable on Religion and Social Welfare Policy. And America has been well-served because of those efforts.

Education Reform
Before becoming President, candidate George W. Bush ran on a platform that included among other things, a) education reform, and b) reaching across the aisle to get things done in Washington. Both of those objectives were met in the No Child Left Behind Act of 2001 (Public Law 107-110), often abbreviated in print as NCLB, and sometimes pronunced "nicklebee". Immediately after taking office, George W. Bush proposed the legislation on January 23rd, 2001. Congress based its legislation on the "blueprint" proposed by the president. The legislation was coauthored by Representatives John Boehner (R-OH) and George Miller (D-CA) in the House, and by Judd Gregg (R-NH) and Edward Kennedy (D-MA) in the Senate. The Act, introduced as HR 1 during the 107th Congress, was passed in the House of Representatives on May 23rd, 2001, and in the Senate on June 14th, 2001. In both houses it passed with bi-partisan support. President Bush signed it into law on January 8th, 2002.


President Bush signs No Child Left Behind bill.
Bush said that the goal of the legislation was to demand accountability from the public schools to address "the soft bigotry of low expectations" that had beset schools for so many years. It also provided parents with more flexibility in choosing which schools their children could attend, promoted an increased focus on reading, and reauthorized the Elementary and Secondary Education Act of 1965 (ESEA). First Lady Laura Bush, herself a former school teacher, no doubt helped to influence the original legislative "blueprint" put forward by the President.

NCLB employed the theory of "standards-based education reform", which is founded on the belief that setting high standards and establishing measurable goals can improve individual outcomes in education. NCLB required states to develop assessment tests in basic skills that would be given annually to all students in certain grades, in order for those states to continue to receive federal funding for schools. NCLB did not assert a national achievement standard; standards were set by each individual state. This was done to keep in line with the principle of local control of schools, and in order to comply with the Tenth Amendment to the United States Constitution, which specifies that powers not granted to the federal government nor forbidden to state governments are reserved powers of the individual states.

NCLB also imposed consequences for schools that could not demonstrate "adequate yearly progress", which was defined as annual improvement in test scores (e.g. each year, a school's fifth graders must do better on standardized tests than the previous year's fifth graders). Schools which received Title I federal education funding, were mandated to make such annual progress or else be put on a list of "failing schools" to be published in the local newspaper. Parents of children in a "failing school" were given the option to transfer their children to another school. In addition, the Title I funding of a "failing school" was cut, and the school was forced to provide special tutoring for its students.


Bush speaks about No Child Left Behind.

I think the No Child Left Behind Act is one of the significant achievements of my Administration because we said loud and clear to educators, parents, and children that we expect the best for every child, that we believe every child can learn, and that in return for Federal money we expect there to be an accountability system in place to determine whether every child is learning to read, write, and add and subtract.

This is a piece of legislation that required both Republicans and Democrats coming together, and it is a landmark legislative achievement. But more importantly, it focused the country's attention on the fact that we had an achievement gap that -- you know, white kids were reading better in the 4th grade than Latinos or African American kids. And that's unacceptable for America. And the No Child Left Behind Act started holding people to account, and the achievement gap is narrowing.

When you couple that with a very strong literacy initiative, which [First Lady] Laura [Bush] has been a part of, it begins to focus our whole system on solving problems early, and not accepting this premise that you're just going to move people through the system and hope for the best, and insisting upon high standards for every single child. And I'm very proud of that accomplishment, and I appreciate all those here in Washington and around the country that have worked hard to see that the promise of No Child Left Behind has been fulfilled.

--President George W. Bush, Bush on His Legacy, 28 November 2008

Initially, NCLB was enacted with bipartisan support but was later criticized for placing too much emphasis on testing, and for Washington's failure to provide the money that schools needed to meet the demands for improvement. But as with any topic of debate, there are always two sides to the story, and supporters of the legislation insisted it was working. In December 2006, the U.S. Department of Education released a report quoting improving test scores and pointing to success stories. Here is an excerpt...

The long-term Nation's Report Card (NAEP) results, released in July 2005, showed elementary school student achievement in reading and math at all-time highs and the 'achievement gap' closing.

For America's nine-year-olds in reading, more progress was made in five years than in the previous 28 combined.

America's nine-year-olds posted the best scores in reading (since 1971) and math (since 1973) in the history of the report.

America's 13-year-olds earned the highest math scores the test ever recorded.

Reading and math scores for African American and Hispanic nine-year-olds reached an all-time high.

Math scores for African American and Hispanic 13-year-olds reached an all-time high.

Achievement gaps in reading and math between white and African American nine-year-olds and between white and Hispanic nine-year-olds are at an all-time low.

The state-by-state Nation's Report Card results, released in October 2005, showed improved achievement in the earlier grades in which NCLB is focused. In the last two years, the number of fourth-graders who learned their fundamental math skills increased by 235,000 -- enough to fill 500 elementary schools!

Across-the-board improvements were made in mathematics and in fourth-grade reading.

African American and Hispanic students posted all-time highs in a number of categories.

Forty-three states and the District of Columbia either improved academically or held steady in all categories (fourth- and eighth-grade reading, and fourth- and eighth-grade math).

The Nation's Report Card Trial Urban District Assessments for Reading and Math, released in Dec. 2005, showed students in select urban school districts improving faster than their peers over the last two years.

Fourth-graders in 8 of 10 urban districts made larger gains in math than the national average.

Fourth-graders in 7 of 10 urban districts made larger gains in reading than the national average.

Eighth-graders in 7 of 10 urban districts made more progress in basic math skills than the national average.

The Nation's Report Card Science 2005 Report found significant academic gains by fourth-graders.

Overall, fourth-graders improved four points in science achievement over 1996 and 2000 levels, with the lowest-performing students making the largest gains.

African American and Hispanic fourth-graders made significant gains as well, narrowing the achievement gap.

And the Nation's Report Card Trial Urban District Assessment for Science, released in Nov. 2006, showed narrower 'achievement gaps' for low-income students than for the entire student body, between nearly all of the participating school districts and the nation.

--U.S. Dept. of Education, No Child Left Behind Act Is Working, December 2006

Some of the criticism against NCLB focused on special needs students, students who were handicapped, and students who were learning to speak English. According to the critics, such students would not be able to perform as well as other students and would inherently bring down test scores. The Eduwonk blog had this to say in response to such critics...

NCLB’s “adequate yearly progress” provisions have some problems, sure. But the reality is that they’re not nearly as bad as the rhetoric about them, and some of the problems fall in the “lesser of several bad choices” category because of the current state of play of state policy. These Hill staffers are not as dumb or out of touch as people think... [an Olson-Hoff article] in Education Week debunks some of the common myths, especially the scapegoating of English-language learners and special-ed kids. In the end, despite some sharp edges, we’re back to the question of whether we’re going to hold schools accountable for educating discreet subgroups of kids, or not. In other words, is the right unit of analysis kids or schools? And also, again we face the disconnect between really grim achievement gaps and concerns that NCLB is telling us that some schools aren’t doing a very good job... those kids do go to school somewhere! --The Horrid AYP Unmasked!, 18 December 2006

Some critics suggested that NCLB created incentives for schools, districts, and states to manipulate test results. For example, schools have been shown to employ "creative reclassification" of drop-outs (to reduce unfavorable statistics). NCLB also may have caused some states to lower their official standards. Because each state could produce its own standardized tests, a state could make its statewide tests easier to pass, thereby increasing test scores. Missouri for example, improved testing scores but openly admitted that they had lowered the standards. Critics also said that punitive measures against "failing schools" created incentives to set expectations lower rather than higher. Critics even said the legislation tended to increase segregation by race and class, to be followed-up by pushing low-performing students out of school altogether.

Other critics argued that NCLB caused teachers to "teach to the test", focusing all their efforts on things that they knew would be included in the tests to the exclusion of everything else. For example, the special focus of NCLB on reading and math might mean that other areas of learning, including music, art, or physical education, would take a lower priority or be eliminated altogether. But in 2006, a study by NAMM/MENC found that NCLB apparently had little impact on music education. According to the study, of those surveyed, 76% said NCLB had no effect on music education, while only 20% said that NCLB was having an impact on music eductation. But, critically, there was almost an even split between those who said NCLB was having a positive impact versus those who said it was having a negative impact. In fact, the balance swung just barely in favor of positive (51 percent to 49 percent).

While there may be some truth in these various criticisms of NCLB, none of them reflects poorly on President Bush. In his attempt to reform education, George W. Bush made a good-faith effort to establish a plan whereby schools would be held accountable for their performance, or lack thereof. His goal was to eliminate the "achievement gap" between wealthier suburban white students, and the less-fortunate urban African-American and/or Latino students. It was not his intention to see states lower their educational standards, or to have schools come up with "creative reclassifications". His intent was to motivate schools and teachers to get down to basics, and to perform their function of teaching. His intent was to "get results" and to "eliminate complacency".

On the other hand, educators and/or state employees may have succumbed to the temptation to lower standards, manipulate test scores, or willfully circumvent the law in order to achieve some advantage at the expense of their students' education. If such is indeed the case, then any and all of the blame lies with these so-called "educators" and/or state employees who thus chose to lie, cheat and steal. Laws such as NCLB may create "negative incentives", but no one is forced to break the law. When laws such as NCLB are written and enacted, it is assumed that honest citizens will make a good-faith effort to comply with the law, not to circumvent it for face-saving or financial reasons; and particularly not at the expense our children's education.

Health Care
Medicare was created in 1965 as a health insurance program administered by the United States government, particularly for senior citizens aged 65 and over, or who meet other special criteria. Since then, the role of prescription drugs in U.S. health care has significantly increased. As new and more expensive drugs have come into use, patients have found prescriptions harder to afford, particularly the elderly for whom Medicare was designed. As early as the 1980s, stories began emerging describing the plight of seniors on fixed incomes who were faced with choosing between buying food or medicine. It was an often-repeated and common complaint.

Bill Clinton ran heavily on health care reform during the 1992 presidential election campaign in an effort to address such problems. After taking office in 1993, he established a task force with First Lady Hillary Rodham Clinton as its chairperson. The goal of the task force was to develop a comprehensive plan for implementing universal health care for all Americans, and was to be the cornerstone of Clinton's first-term agenda.


Hillary Clinton discusses health-care plan - 1993.
The Clinton Health Care Plan of 1993 came under strong opposition from conservatives, libertarians and the health insurance industry. Even Democrats, rather than uniting behind the President's original proposal, offered a number of competing plans. By September 1994, the final compromise Democratic bill was declared dead by Senate Majority Leader George Mitchell. Opponents of the plan have continued to deride it as "HillaryCare". By the time Bill Clinton left office, virtually nothing had been done to improve or reform health care. George W. Bush set out to rectify that situation through implementation of the Medicare Prescription Drug Benefit.

Officially known as the Medicare Prescription Drug, Improvement, and Modernization Act (Pub.L. 108-173, 117 Stat. 2066), it is also called the Medicare Modernization Act (MMA). The bill was introduced in the House of Representatives on June 25, 2003 as HR 1, sponsored by Speaker Dennis Hastert. After contentious debate, close votes (including some vote-reversals by Republican House members), the legislation finally passed on November 25th, 2003 and was signed into law by President Bush on December 8th.


Bush signs Medicare Modernization Act.
This legislation produced the largest overhaul of Medicare in the public health program's 38-year history. It was initially estimated to cost less than $400 billion over 10 years. Conservative Republicans had promised to vote against the bill if it cost more than that. Only a month after the bill was signed into law, the ten-year cost estimate was revised to $534 billion. It was reported that an administration official, Thomas A. Scully, had concealed the higher estimate and threatened to fire Medicare Chief Actuary Richard Foster if he revealed it. By early 2005, the White House Budget had increased the 10-year estimate to $1.2 trillion. Critics of the bill were primarily fiscal conservatives and libertarians who opposed the high price tag and its expansion of entitlement programs.

At the signing ceremony, President Bush said the measure would give older Americans "better choices and more control over their health care, so they can receive the modern medical care they deserve. Our government is finally bringing prescription drug coverage to the seniors of America." He said that then-President Lyndon Johnson, when he signed the Medicare Act of 1965, established a "a solemn promise to America's seniors. We have pledged to help our citizens find affordable medical care in the later years of life. And today, by reforming and modernizing this vital program, we are honoring the commitments of Medicare to all our seniors."

According to a report issued by the strongly Left-leaning 'Center for American Progress' in December 2008, the Centers for Medicare and Medicaid Services (CMS) does not have enough data to fully determine the effectiveness of the Bush Medicare Part D prescription drug program. CMS is the agency that administers Medicare, and it collects and disseminates data for both governmental and non-governmental research purposes. The lack of data is blamed on the fact that Medicare Part D is implemented by many competing private firms who are not required to provide such data.


Volunteer assists prescription drug plan enrollment.
What is known however, is that about 57 percent of all Medicare beneficiaries -— roughly 25 million seniors —- are now enrolled in either stand-alone privately operated drug plans, or private Medicare Advantage plans, under which beneficiaries receive all of their health services, including drugs. We also know that the creation of Medicare Part D has dramatically increased the number of seniors with prescription drug coverage. According to a recent survey, only 8% of seniors lacked drug coverage in 2006, compared with about 33% before the program was introduced. It is also known that about half of all beneficiaries qualify for Part D’s Low-Income Subsidy program and face virtually no out-of-pocket costs.

In October 2007, AARP conducted a telephone survey of 400 Medicare beneficiaries aged 65 and older with the drug benefit. Results suggested that people who have Medicare Part D drug coverage report high levels of satisfaction with the plan and their premiums, with many stating that prescription drugs are more affordable now than they were prior to their enrollment.

About eight in ten individuals (78%) aged 65 and older with Medicare Part D prescription drug coverage said they think they made a good choice in selecting their drug plan. About 17% said they were extremely satisfied, and 42% said they were very satisfied with their current plan. About 20% of respondents with Medicare Part D coverage said they thought their prescription drugs were much more affordable, 24% thought somewhat more affordable, and 19% said just as affordable as they were before their enrollment.

As previously stated, the primary critics of the legislation were conservatives and libertarians. Many felt that this was nothing more than another liberal give-away program. Some even went so far as to suggest that it resulted in the significant Republican losses at the polls during the 2006 mid-term elections. They argued that Republicans were seen as having abandoned their "core conservative values". But there were plenty of other reasons for the mid-term election results, and it seems hard to believe that Medicare Part D played a major role in the Republican losses. For example, it seems highly unlikely that voters would be persuaded to elect moderate or liberal Democrats because Republicans had not been "conservative enough".


There were in fact, a number of conservative elements to the legislation. Coverage was to be available only through private insurance companies and HMOs versus direct government administration. With a wide array of plans available, participants were provided with choices that would best serve their particular needs. Participation was voluntary rather than mandatory, unlike most universal health care proposals. The government was barred from negotiating with pharmaceutical companies to avoid having the government unfairly dictate prices to the drug manufacturers (producing a potentially negative impact on profits). The program provided a subsidy for large employers to discourage them from eliminating private prescription coverage to retired workers. And it prohibited the government from establishing a formulary, in order to prevent the government from dictating which drugs would be covered and which would not.

For President Bush, the prescription drug benefit was simply another example of "compassionate conservatism". People needed help, and in his own words, "It is compassionate to actively help our fellow citizens in need." President Bush wanted to get results because, "It is conservative to insist on responsibility and on results." The legislation was targeted and focused. It incorporated conservative elements that restricted unwarranted government involvement. And he saw this legislation as a way to "make a real difference in people's lives."

HIV-AIDS Relief
In 2003, President Bush launched the 'U.S. President's Emergency Plan For AIDS Relief' (PEPFAR) to combat global HIV/AIDS - the largest commitment by any nation to combat a single disease in history. The initial legislative authorization for PEPFAR was P.L. 108-25, the United States Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Global AIDS Act). According to its website, through FY2013 PEPFAR plans to work in partnership with host nations to support:

Treatment for at least 3 million people. Prevention of 12 million new infections. Care for 12 million people, including 5 million orphans and vulnerable children. Training of 140,000 new health care workers in HIV/AIDS prevention, treatment and care.

Bush being thanked for his HIV/AIDS program.
PEPFAR's success has been due in large part to the fact that US funding has gone to faith-based organizations who have been implementing the programs. Here are just two of the many success stories which have come out of PEPFAR...

Namibia: In 1998, the late Archbishop Bonifatius Hausiku of Namibia’s Roman Catholic Church announced the launch of Catholic AIDS Action, a support group for orphans and vulnerable children. Two years later, Catholic AIDS Action, with support from an international NGO, had built a national network of organizations providing home-based care and other services to people living with and affected by HIV/AIDS. In partnership with the Namibian government, PEPFAR helped the network expand to include other local FBOs such as the Evangelical Lutheran Church, Rhenish Church, Apostolic Faith Mission, Catholic Health Services, Lutheran Medical Services, Church Alliance for Orphans, Lifeline-Childline, Philippi Trust and the Evangelical Lutheran Church AIDS Programme.

In collaboration with the Namibian government and with PEPFAR support, Family Health International helped to strengthen these and other faith-based initiatives through technical assistance and training in program management, finances, monitoring and evaluation. Services provided by the network of FBOs included HIV counseling and testing services; support groups; anti-retroviral treatment; prevention of mother-to-child HIV transmission programs; care and support for orphans and vulnerable children; and training for counselors for both government-managed and community-based programs.

In addition, FBOs increasingly began addressing the underlying community issues that amplify the epidemic’s impact, including alcohol abuse, domestic violence and inadequate nutrition for vulnerable community members. The synergy between faith-based initiatives and Namibian government programs has been, and will continue to be, a key to the successful national response to HIV/AIDS.

South Africa: In South Africa, a similar program is fighting the HIV/AIDS epidemic. Nazareth House, an FBO located in Cape Town, was the first Catholic orphan care institution in South Africa to provide pediatric anti-retroviral therapy for the HIV-positive orphans it cares for. Nazareth House is currently caring for children made orphans by AIDS and adults living with HIV. Most of the patients in their charge can no longer care for themselves or be cared for by their family or community, due to the complexity or severity of their symptoms.

Nazareth House was one of the first sites where anti-retroviral therapy was provided as part of the Choose to Care initiative. By replicating similar small-scale programs implemented through the diocesan and parish system, the Catholic Church has been able to scale-up HIV programs that remain rooted in and responsive to the needs of local communities. According to UNAIDS, the Joint United Nations Programme on HIV/AIDS...

This approach has been proven to be effective as is shown in a study recently researched and written by Rev. Robert J. Vitillo, Special Adviser on HIV for Caritas Internationalis. The study has now been published as part of the UNAIDS Best Practice Collection as an example of how a coordinated response to the epidemic made by a faith-based organization has increased HIV prevention education, care and support to communities affected by AIDS as well as complementing governments’ efforts to achieve universal access to prevention, treatment, care and support [emphasis added]. --A Faith-Based Response To HIV In Southern Africa, UNAIDS, 20 December 2006

Getting Results: The president's HIV/AIDS program spent more than $15 billion across Africa from 2003 to 2008. Principally focused on providing Africans with anti-retroviral drugs to treat the disease, the program has been such a success that it has been extended to 2015 at $48 billion. Approximately 1.7 million people were on the therapy at the end of 2008. Bush also initiated a five-year, $1.2 billion effort to combat malaria which has provided 4 million insecticide-treated bed nets and 7 million drug therapies to vulnerable people.


President Bush hands out mosquito nets - Feb 2008.
The Bush AIDS/HIV funds have clearly been credited with saving lives. Even critics of the program concede what is obvious to thousands of HIV-positive patients, like James Kan, a patient at a clinic in the Tanzanian capital -- the program has worked. "I would have died," Kan said. "Yeah, that is exactly what could have happened."

The money from Washington turned clinics, which formerly dispensed little more than advice, into institutions of healing; institutions that dispense anti-retroviral drugs for free. Those drugs would have otherwise cost thousands of dollars each month. "Funding for this program has really made big changes," said Dr. Twalid Ngoma, who oversees the Ocean Road Cancer Institute in Dar es Salaam, where Kan and hundreds of other AIDS patients are treated. "There is now hope. Before that, HIV was a death sentence. Everybody died."

Public health worker Amy Cunningham, director of Columbia University's International Center for AIDS Care and Treatment Programs in Tanzania said, "Without these drugs, and without the kinds of services we've been able to help Tanzania carry out, you would have a huge swath of a missing generation. A whole generation has been able to continue living." While the pandemic still remains a continental scourge, nearly everyone familiar with the Bush administration program concedes that the progress in combating the disease has been undeniable.

Other African Initiatives
A little known fact for many Americans is that President George W. Bush has established an enduring legacy in Africa. When Bush traveled to sub-Sahara Africa in February 2008, he was greeted by large and tumultuous crowds of admirers. Polling data from the Pew Foundation showed that approval ratings for the United States exceeded 80 percent in many African countries, some with large Muslim populations. In Darfur, some families named their newborn sons George Bush. What was the reason for such admiration?


Cheering crowds greet Bush in Africa.
In Sudan, the United States played a central role as peacemaker in ending a 20-year civil war between the Arab north and African south, which killed 2 million people. America played an important role as mediator in Burundi, Liberia, Northern Uganda, Sierra Leone, and the Democratic Republic of the Congo after civil wars devastated all five countries.

It was the Bush administration that first raised the alarm about the atrocities in Darfur, organized a massive humanitarian relief effort to save people in the displaced camps, and rallied an international coalition to send peacekeeping troops to restore order through the United Nations and the African Union. Even though the civil war continued, casualties declined and people were being fed by aid agencies, thanks to US government generosity. As a result, President Bush was very popular among the Africans in the camps.


President Bush speaks about Darfur.
The Bush administration doubled foreign aid worldwide over his eight years in office, the largest increase since the Truman administration, and he used it to encourage poor countries to undertake political and economic reform. Here again, President Bush wanted to see "results", so his foreign aid came with a caveat calling for "responsibility". Bush did not simply throw foreign aid money away.

Total US government development aid to Africa alone quadrupled from $1.3 billion in 2001 to more than $5 billion in 2008, and is scheduled to go to $8.7 billion in 2010, principally for education, healthcare, building civil society, and protecting fragile environments. It should be noted that primary school enrollment in Africa is up 36 percent since 1999.

Africa received $3.5 billion in additional funds from Bush's Millennium Challenge Corporation initiative, which rewarded poor countries that encourage economic growth, govern well, and provide social services for their people. The Africa Growth and Opportunity Act, approved in 2000 and reauthorized in expanded form in 2004, provided trade benefits with the United States for 40 African countries that implemented reforms to encourage economic growth.

Since 2001, US exports to Africa have more than doubled to $14 billion a year, while African exports to the United States more than tripled to $67 billion, of which $3.4 billion has been in goods other than oil. USAID has provided more than $500 million in trade capacity building for poor countries to access international markets, which is the only way Africa will escape the poverty that has for too long oppressed the continent.


Bush greeted warmly in Tanzania.
While Bush's critics have given him little credit for his African initiatives, they will be among his most enduring legacies in a region of the world neglected by policymakers from both parties for far too long. Africans will long remember what Bush critics have ignored.

Even Vanity Fair, one of President Bush's harshest critics, was forced to acknowledge his role in African development. In a series of (20) cover photos for the July 2007 edition, photographer Annie Leibovitz captured (21) people "who put their famous faces to work for this issue". Called "The Africa Issue", Vanity Fair focused all of its stories in this issue on Africa, with special guest-editing by Bono. President Bush appeared on (2) of the covers as seen below.

Click either image to enlarge.
Vanity Fair said their covers were "21 people shout-outs for the challenge, the promise, and the future of Africa". What follows is their almost grudging "tribute" to George W. Bush...

GEORGE W. BUSH
We at Vanity Fair didn't think there could be a silver lining to the Bush administration, but perhaps it is, of all things, President George W. Bush's work for Africa. As the Organization for Economic Co-operation and Development — an independent monitor of global spending — reports, the U.S. has quadrupled aid to the continent over the last six years. In his 2003 State of the Union address, Bush pledged $15 billion to fight AIDS primarily in Africa, and two years later pledged a $1.2 billion initiative to fight malaria in the 15 African countries hardest hit by the disease.

American liberals may not appreciate President George W. Bush, but millions of people at home and abroad, have been helped by him.