The Moral Scales

WASHINGTON -- How much do seven members of the U.S. Senate weigh?

Eyeing them -- Tom Coburn, Jim DeMint, Jeff Sessions, Saxby Chambliss, David Vitter, Jim Bunning, Richard Burr -- I'd guess they probably come in at about 1,300 pounds. These are the Republicans who have signed a hold letter, preventing action on the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR).

Now, how much do 3 million HIV/AIDS-infected people -- the treatment goal of a reauthorized PEPFAR -- weigh? This is a more difficult calculation. Adults with advanced forms of the disease can weigh about 60 pounds. Children with AIDS are like a shadow falling on a scale. Maintaining weight becomes difficult with vomiting and diarrhea, with tuberculosis and fungal infections, with cancers such as Kaposi's sarcoma and lymphoma.

Even so, you'd think that a few million of these wasting bodies would weigh more on the moral balance than seven senators. But so far, you'd be wrong.

It is the nature of the Senate that the smallest of minorities can impede the work of the majority. But it takes a conscious choice -- an act of tremendous will and pride -- for members to employ these powers against an AIDS bill with overwhelming bipartisan support.

The seven, led by Coburn, complain that the reauthorization is too costly. They object to "mission creep" -- the funding of "food, water, treatment of other infectious diseases, gender empowerment programs, poverty alleviation programs" -- as though people surviving on AIDS treatment do not need to eat, work or get their TB treated. And the senators are concerned that AIDS funds might be used for things such as abortion referrals and needle distribution, though the legislation doesn't mention these possibilities. So they are pushing for the extension of a superfluous spending mandate requiring that at least 55 percent of PEPFAR resources be used for treatment, on the theory that this will starve "feckless or morally dubious" prevention programs.

For all of conservatism's evident virtues, it can have one furtive, seedy vice: A justified suspicion of government can degenerate into an anti-government ideology -- rigid, stingy and indifferent to human suffering. Conservative concerns on family planning and abstinence in the PEPFAR reauthorization are not imaginary, but they could be resolved through good faith negotiations, as they were in the House of Representatives. A generalized hostility to AIDS prevention, however, is destructive. Given that there are about 2.5 new HIV infections for every person starting on AIDS drugs, there is no way to control the pandemic through treatment alone. And because treatment is less expensive than it used to be, PEPFAR is meeting its treatment goal for less money. The 55 percent treatment floor would force the program to waste money in pursuit of an arbitrary, nonsensical spending target -- the worst kind of congressional earmark.

Other members of the Senate Republican conference seem content to stand by and watch Coburn undermine the bill, since they have their own, quiet concerns about PEPFAR's price tag. But the legislation is an authorization, not the appropriation (which comes later), so the $50 billion figure means little. These Republicans are objecting to a placeholder, taking a baseball bat to a vapor.

President Bush has yet to push for PEPFAR's reauthorization as his top legislative priority, so Majority Leader Harry Reid and Minority Leader Mitch McConnell feel little pressure to roll over Coburn's objections -- which they could do, since there are more than 60 "yes" votes.

Reid supports the legislation but seems uninterested in scheduling floor time without assurances from Republicans that the debate will be short and the number of amendments limited. If it passes, after all, President Bush will get much of the credit. The political calculation must be tempting: Why not allow seven, white Republicans to discredit their party by blocking a lifesaving bill for Africa? And there is an added bonus: Coburn is an adviser on health issues to John McCain.

Given these obstacles, supporters of the PEPFAR reauthorization now estimate a 50 percent chance it will be shelved until next year. Without a five-year U.S. commitment on AIDS funding, other countries would be reluctant to put new people on treatment. And lives would be lost.

Each of the Coburn Seven counts himself pro-life. If a bill came to the Senate floor that would save millions of unborn children, one assumes that pro-life members would push to improve it, accept a few necessary compromises, and then enthusiastically support the legislation.

It is difficult to imagine why pro-life legislation involving millions of Africans should be viewed differently.