The New York Times - June 21, 2008

That will undermine the Bush administration's leadership in combating the global scourge of AIDS. It is long past time for President Bush himself to get engaged in breaking this legislative impasse. He should press the Republican leadership and seven recalcitrant Republican senators to cooperate in an orderly and expeditious vote, unencumbered by a filibuster or the introduction of myriad amendments designed to eat up time.

The House passed its version of the bill in April by a 308-to-116 vote that had bipartisan support and an endorsement from the White House. It would authorize spending $50 billion over the next five years to combat AIDS, tuberculosis and malaria, a big increase from the $19 billion spent in the first five years of the President's Emergency Plan for AIDS Relief and much more than Mr. Bush had requested. The added money is needed to treat or care for millions more people infected with H.I.V., the virus that causes AIDS; to provide prevention services to tamp down the AIDS epidemic; and to expand the campaigns against malaria and tuberculosis.

Unfortunately, the Senate's version of the bill, which was approved by the Foreign Relations Committee in a 18-to-3 vote, has bogged down in procedural uncertainties. A group of seven Republican senators, led by Tom Coburn of Oklahoma, has placed a hold on the bill unless their concerns are met. They contend that the $50 billion spending level is irresponsible, and they object to the elimination of a previous requirement that 55 percent of the AIDS money be spent on treatment as opposed to prevention or other services.

These objections are unpersuasive. Even a $50 billion American contribution over five years matched by substantial contributions from other industrialized nations would not finance all the treatment and prevention programs needed to quell the epidemic. The real issue is how wisely the money is spent. Mr. Coburn wants to ensure that the bulk of the American money goes for treatments that will save lives. But earmarking a specific percentage of funds to be spent on particular activities hampers the flexibility and effectiveness of the program, according to both the Institute of Medicine of the National Academy of Sciences and the Government Accountability Office. One of the most promising prevention measures, circumcision of males, is apt to be very expensive, and it would be a shame if it got insufficient support simply because an arbitrary percentage of the program's budget had to be spent on treatments.

The bill is currently stalled because Senate leaders seem reluctant to bring it to the floor absent an agreement that would limit debate and expedite a vote. Some advocacy groups that don't like specific provisions would prefer to wait for a new president and Congress. But no one can be sure that, in a faltering economy, there will still be bipartisan support for a $50 billion bill next year. It would be best to pass the bill in time to strengthen the president's hand at the G-8 summit in early July.

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