Are Americans responsible for sickness & death in Sudan? The answer to the titular question is “yes,” according to Nicholas Kristof, writing recently in The New York Times. The U.S. government has the resources and know-how, he argues, to save lives in Africa from AIDS and other diseases, but has ceased to do so since January, when President Trump dismantled the U.S. Agency for International Development. He laments in particular that the closure of USAID phased out the President’s Emergency Plan for AIDS Relief (PEPFAR), a program that started over twenty years ago under President Bush and supplied antiviral medicines to people in poor countries suffering from the disease. Kristof points in particular to an eight-year-old child in Sudan who died recently because she no longer had access to those medications, and he lays her death at the doorstep of the Trump Administration.
PEPFAR is just one of dozens of foreign-aid programs funded by the U.S. taxpayer. With a budget of $6.5 billion per year, the program was originally set up to be funded for only five years, and recipient countries were eventually expected to step up and take charge of their own health programs. That requirement made a lot of sense, but the program was never going to be phased out: advocates were always poised to make Kristof’s point that children would die if the program ever ended. Like other programs started and paid for in Washington, PEPFAR was due to continue forever.
Kristof is one of many members of a large brigade who think that the U.S. government must address this and every conceivable problem here and around the world, regardless of the accumulating costs of trying to do so. The United States must solve the AIDS crisis, he writes, but, as others insist, it must also maintain peace across the globe, end wars in Ukraine and Gaza, operate an open border so that any dissatisfied person in the world can enter the country, consume exports from dozens of countries so they can keep their people working, and invest in renewable-energy projects worldwide—all the while maintaining its own domestic welfare state and borrowing the funds to keep the whole enterprise afloat.
This is an expensive operation. The U.S. government spends $7 trillion per year, borrows about $2 trillion, and sits atop a total debt of $37 trillion, with interest payments now exceeding $1 trillion per year. Everyone agrees that the U.S. government must somehow address its debt crisis before those interest payments claim an unsustainable share of the federal budget. Kristof may agree with this as well, but apparently not enough to call for cuts in his favorite programs. Cut someone else’s program, but don’t touch mine. Everyone says the same thing—People will suffer!—so every program goes on forever.
But Kristof’s view that the United States is responsible for deaths in Sudan is bankrupting the country.
In the post-war era, the United States has evolved from a nation-state, mostly minding its own business and defending its own interests, to a kind of universal state responsible for groups and issues around the globe, often at the expense of its own citizens. President Trump is trying to reverse that process by refocusing the country’s attention on the problems of its own citizens and its own interests as a nation-state.
That means several things: using the U.S. military to defend national interests rather than supranational ones (such as nation-building abroad); restoring the nation’s borders; reestablishing distinctions between citizens and noncitizens; letting other countries pay for their own defense; encouraging investors to promote manufacturing here, to make items to sell in the United States and abroad; allocating taxes paid by Americans to programs that assist Americans; saving money where possible to reduce the government deficit; and challenging the idea that the United States must look out for the entire world. It is a difficult enterprise: he is aiming to reverse a process that has been in motion for eighty years.
Kristof and others will see this as a harsh judgment on causes they think are important, but it is the kind of approach the United States will eventually have to follow if it is going to sustain its existence as a functioning nation-state. The United States will never prosper as a “universal state,” since it lacks the resources to do so. As President Trump sees it, the United States must defend and support its own people before extending its benevolence to those in other countries, poor or sick though they may be. That approach has its own moral justification—for, as some say, “charity begins at home.”
