The Clinton Global Initiative (CGI) has been in existence for several years now, with a focus on three major killer and impoverishing diseases, namely malaria, tuberculosis and HIV-AIDS.

By arranging to buy FDA-approved generic medicines at concessional prices, CGI has not only been able to make a significant health impact on populations where these diseases are rampant, but has also brought about savings and freed money to be diverted towards use in infrastructure development, education and so on in those countries.

CGI 2013 is being held but a few days prior to Americans signing up for the new system of insurance provided in the Affordable Care Act (ACA), on 1st October 2013. It will be recalled that ACA was one of the first pieces of legislation that President Obama pressed ahead with and got passed during his first term, despite much resistance by Republicans and even reluctance on the part of some of his own party members, the Democrats. The theme of CGI 2013 is ‘Mobilising for Impact’, and it was not surprising therefore that President Obama was invited to CGI to talk about ACA. The full account of the conversation between the two Presidents, Obama and Clinton, has been made available as a press release by the White House.

What strikes one as one goes through that script is the underlying ethos of politeness, decency, mutual respect, and civilised exchange, with pithy humour and some well-intentioned barbs thrown in, not to mention the high and refined level at which the discourse is pitched. It is true that both the Presidents are Democrats, but their regard for the controversial and often vilified and ridiculed George Bush (remember ‘bushisms’?) and their acknowledgement of his ‘stunning legacy’ is not only noteworthy, but is testimony perhaps to a ‘continuity of state’ emanating from the White House which makes America what it is, the strongest country in the world in terms of influence despite its economic woes and ‘Satanic’ depiction.

It is Mrs Hilary Clinton who set the tone, and it will be remembered that she played a very critical role – ‘shaping the conversation’ to use President Obama’s words – in Health Care Reform during her husband’s Presidency. True, it did not happen – but now Obama is taking the agenda forward. Let’s look at the introductory remarks of that lively and high-end conversation, held on September 24, 2013 at the Sheraton New York Hotel and Towers:

MRS CLINTON: Good afternoon, everyone. (Applause.) Well, thank you. Thank you very much. I have the great pleasure to introduce our next two speakers, who are about to have a conversation concerning health care. And I thought hard about how to introduce these two men. (Laughter.)

And the more I thought about it, the more I realized how much they have in common. They are both left-handed. (Laughter.) They both love golf, a game that does not often reciprocate the love they put into it. (Laughter.) They both are fanatic sports fans and go to great lengths to be in front of the TV or on the side of the court or the field. They both are master politicians. Each of them has only lost one election. (Laughter.) They are both Democrats. They have fabulous daughters. (Laughter.) They each married far above themselves. (Laughter and applause.) And they each love our country.

And so please join me in welcoming Number 42 and Number 44, Bill Clinton and President Barack Obama. (Applause.)

PRESIDENT OBAMA: Mr President. (Laughter.)

PRESIDENT CLINTON: Are you interviewing me?

PRESIDENT OBAMA: That would be bad. I’ve been talking a lot today.

PRESIDENT CLINTON: I want to thank you for giving Hillary a job. That was a good thing you did. (Laughter.) Thank you for coming.

PRESIDENT OBAMA: Well, it is wonderful to be back. And let me start just by saying to all the people who have for years now supported the incredible efforts of CGI, thank you. Because wherever we travel, all across the globe, we see the impact that it’s making every single day. And we’re very proud of what you all do.

And let me say that we still miss our former Secretary of State. (Applause.) And I should add that there’s nothing she said that was not true, particularly the part about us marrying up. (Laughter.)

Can we imagine two ex-Prime Ministers or Presidents of our country similarly sharing a platform and debating a subject of capital importance for the country in like manner? No comments.

Here is what President Clinton have to say about President Bush’s legacy:

‘… when the President (NB: Obama) took office, our program, begun under President Bush, PEPFAR, was giving antiretroviral medicine to 1.7 million people. Because of an agreement that I made with President Bush to use generic drugs that were approved by the FDA, about half our drugs were being purchased in that way. Under President Obama, we’ve gone to 99 percent. We are treating more than 5.1 million, three times as many for less money. (Applause.)

That is a stunning legacy — so that more money has been put into malaria medicine, bed nets, so you saved a lot of money and saved more lives while doing it. And I’m very proud of that. And I want to thank you for it. It’s important. (Applause.)’

Through CGI, an ex-President (Clinton) was collaborating with an incumbent President (Bush) to drive a worldwide programme, for, as noted by President Clinton, the conversation ‘was about domestic and international health, and America’s role in it.’ Having established CGI as an important stakeholder in international health, Clinton had turned his focus this time round on the domestic front, and was now supporting Obama in the implementation of ACA. He next invited Obama to make his case, which the latter did with his usual clarity and frankness. A few extracts from his intervention will illustrate this:

‘I think it’s important to remember that health care is the economy. A massive part of our economy. And so the idea that somehow we can separate out the two is a fallacy.

Second, the effort for us to deal with a multifaceted health care crisis has been going on for decades. And the person who just introduced us, as well as you, early in your presidency, had as much to do with helping to shape the conversation as anybody.

The fact is that we have been, up until recently, the only advanced industrialized nation on Earth that permits large numbers of its people to languish without health insurance.

…the structural deficit that we have is primarily based on the fact that we have a hugely inefficient, wildly expensive health care system that does not produce better outcomes.

And if we spent the same amount of money on health care that Canada or France or Great Britain did, or Japan, or any other industrialized country, with the same outcomes or better outcomes, that essentially would remove our structural deficit, which would then free up dollars for us to invest in early-childhood education and infrastructure and medical research and all the other things… So my view when I came into office was we’ve got to get the economy growing. But… also… start tackling some of these structural problems that had been building up for years. And one of the biggest structural problems was health care. It’s what accounts for our deficit. It’s what accounts for our debt. It causes pain and misery to millions of people all across the country. It is a huge burden on our businesses.’

He went on to spell out the salient points about his proposed health reform, underling that ‘I don’t have pride of authorship on this thing. I just want the thing to work.’ No question here of disputed maternity or paternity: there’s work to be done for the country, and all men and women of goodwill let’s put shoulder to shoulder and do it, just do it.

We would strongly advise readers to log on to CGI and go through this instructive and edifying conversation attentively for the insights that it reveals. Whether we will ever apply some of the lessons that are subsumed in it to our local polity is another matter, but perhaps we can always dream and hope…

* Published in print edition on 27 September 2013

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