Universal Iraqi Health Care Comes at Expense of U.S. Needs, Critics Say

[Guest guest]

> washingtonpost.com

>

> Fixing Iraqi Health Care Comes at Expense of U.S. Needs, Critics Say

>

> By Ceci Connolly

> Washington Post Staff Writer

> Friday, October 17, 2003; Page A25

>

> President Bush and first lady Laura Bush have a vision for health care in

> Iraq in which all mothers-to-be receive prenatal care, childhood mortality

> rates plummet and every person has access to virtually free treatment and

> medicine through an extensive network of 1,400 renovated hospitals and

> clinics.

>

> It is a vision that will cost U.S. taxpayers almost $2 billion in the

first

> 18 months -- an amount some lawmakers say is too steep, especially when a

> growing number of Americans cannot afford medical care.

>

> " I certainly understand the need for health care in Iraq, " said Sen.

Debbie

> Stabenow (D-Mich.), who tried unsuccessfully Tuesday to shift $5 billion

> from Iraqi assistance to domestic education, health and construction

projects.

>

> " This administration has a sense of urgency in Iraq that I don't see here

> at home. We see hospitals closing and the number of uninsured going up,

and

> yet we don't see any sense of urgency from this administration. "

>

> The effort to revitalize Iraq's health care system is a source of pride

for

> the Bush administration in a postwar reconstruction program that has often

> been hampered by violence, international squabbling and logistical

> problems. Laura Bush has taken a personal interest, lobbying for

> construction of a state-of-the-art children's hospital in Basra that would

> one day draw patients and physicians from all over the Middle East.

>

> The Bush administration and many humanitarian relief groups say the United

> States has a moral and legal obligation to rebuild Iraq.

>

> " There is no doubt that the one responsible for this is, according to the

> Geneva Conventions, the occupying power, and that is the U.S.-led

> coalition, " Morten Rostrup, international council president of the aid

> group Doctors Without Borders, said recently.

>

> Administration officials point to political and security imperatives that

> make investment in Iraqi schools, hospitals, roads and housing critical.

>

> " If we are successful at rebuilding health care in Iraq, we can start

> turning this terrible war against the terrorists, " Health and Human

> Services Secretary Tommy G. Thompson said in an interview. " We can do that

> better, I think, by using a doctor and medical diplomacy than we can by

> other means. "

>

> Winning the war on terrorism, Thompson suggested, requires doing things

> that " show the Muslim world we really do care about women and children. "

> Medical intervention " is one way we can highlight our compassion. "

>

> But as Congress conducts a fierce debate over the administration's request

> for $87 billion to pay for operations in Iraq and Afghanistan, the

proposed

> medical program for Iraq illustrates the inherent tensions in spending

> American dollars in a far-off land. At home, the deficit is rising,

> unemployment hovers around 6 percent and many voters complain to pollsters

> that Bush is not focused enough on their economic plight.

>

> " The same values that we hold for Iraq we must pledge for all Americans, "

> Rep. Rahm Emanuel (D-Ill.) said. " The same goals we envision for Iraq's

> future, we must envision for America. "

>

> Emanuel and a contingent of liberal House members, in weekly floor

speeches

> dubbed " Iraq Watch, " have contrasted unmet domestic needs with the

> ambitious plans for Iraq. The group cites a long list of what it calls

> neglected domestic programs, such as veterans' health care, schools,

police

> on the street, prescription drugs for seniors and an aging electric grid.

>

> " Restoring the Iraqi health system is a key part of the overall

> reconstruction effort, " said Sen. Edward M. Kennedy (Mass.), the top

> Democrat on the Senate's health committee. " But it is ironic that the same

> administration that wants to improve health care in Iraq is so indifferent

> to the exploding costs and declining coverage that are undermining health

> care here at home. "

>

> William Winkenwerder, assistant secretary for health at the Pentagon, said

> better health care in Iraq will enhance stability in the entire region --

> and improving health appears to be one goal around which a diverse

> collection of nations and nonprofit groups can unite.

>

> " The health care piece is working, and it's working pretty darn well, "

said

> Winkenwerder, who added that he believes the medical successes have not

> received the attention they deserve. " This is one area where the coalition

> has worked closely and effectively, and with a broad international group. "

>

> In the past 12 years, Iraq's health care system deteriorated from being

the

> jewel of the Middle East to Third World-quality care. In 2002, Iraq spent

> $16 million on health care for 25 million people, Winkenwerder said, or

> about 65 cents per person.

>

> Infant mortality rates more than doubled, from 50 deaths per 1,000 born in

> 1990 to 107 per 1,000 in 2000. More than half the pregnant women in the

> country are anemic, and about one-third deliver low-birth-weight babies.

>

> Emergency intervention and repairs have restored much of the system to

> prewar levels, Winkenwerder and Thompson said. Now they hope to make

Iraq's

> health system a regional leader once again.

>

> Of the $87 billion the administration is requesting, $850 million would be

> spent on health care in Iraq -- about $300 million for buying generators

> and medical equipment, and the remainder for major infrastructure work,

> according to the Office of Management and Budget.

>

> Bechtel Corp. is the lead contractor on construction projects at hospitals

> and clinics; other organizations such as Abt Associates and UNICEF have

> received smaller contracts.

>

> That $850 million would be in addition to $211 million spent on health

care

> from July through the end of this year and $946 million targeted for

health

> in the U.S.-installed occupation authority's budget for 2004, said James

> Haveman, the senior U.S. adviser to the Iraqi Ministry of Health.

>

> An additional $100 million for administration and salaries at the

hospitals

> and clinics has been drawn from seized assets of Saddam Hussein.

>

> Some international aid experts have voiced skepticism about the selection

> of Haveman, whose international experience is limited to work with

> International Aid, a Christian relief organization. Ron Waldman of

Columbia

> University said the administration is focused too heavily on bricks and

> mortar, rather than on fundamental public health approaches such as

> teaching mothers to breast-feed, immunizing children and extolling the

> virtues of hand-washing.

>

> He and many others were sharply critical of the administration request for

> $150 million to start work on a new, high-tech hospital in Basra.

>

> " A facility designed to handle top-level pediatric care, plastic surgery,

> burn treatment -- those aren't things that contribute to infant or

> childhood mortality, " Waldman said. " That's like building the penthouse

> before the foundation. "

>

> U.S. leaders are under " tremendous pressure from the doctors and public "

in

> Iraq to " make symbolic improvements, " said Richard Garfield, a professor

of

> clinical international nursing at Columbia University, who spent the

summer

> in Iraq advising the U.S. government and international relief agencies.

> " Hospitals are a black hole; you can pour all the money you have into them

> and still not get the bang for your buck. "

>

> Thompson defended the project, saying, " It's something to leave as a

> legacy " and could eventually draw patients from all over the Middle East.

> House appropriators recently eliminated the Basra hospital and shifted an

> extra $100 million to repairs of existing hospitals. However, the money

for

> the Basra facility is pending in the Senate version of the appropriation.

>

> In a telephone interview from Baghdad, Haveman said 95 percent of the $1.1

> billion he controls is spent on direct medical services such as nutrition

> counseling, vaccines, newborn screening, pharmaceuticals, equipment,

insect

> spraying, disease surveillance and training doctors and nurses who have

not

> heard about new Western techniques in more than a decade.

>

> Haveman nearly gushes over the level of U.S. support in Iraq. Yet he

> realizes the United States cannot maintain those levels indefinitely.

>

> Haveman and the Iraqis have done a needs assessment for health care. Next

> week, at a donors conference in Madrid, he will ask the rest of the world

> for $1.6 billion in aid through 2006.

>

>

> http://www.washingtonpost.com/wp-dyn/articles/A38268-2003Oct16.html

>