Man of the World: The Further Endeavors of Bill Clinton (35 page)

“He was far more easily recognized and to be frank got a warmer reception than I did, and mine was pretty darn good,” he wrote to Sidey. “Rationalization: Not to detract from Clinton’s star power with the crowds, but I have been out of office for a long, long time.”

On the night of their dinner in Colombo with the Sri Lankan president, Bush recalled, they had planned to leave early and get some sleep in decent hotel beds. Keeping their remarks “short and sweet,” they anticipated a swift departure—but then Clinton had lingered with President Kumaratunga and her ministers. He leaned up against a wall, talking and ignoring every signal that it was time to go. At long last, climbing into the limousine where Bush awaited him with diminishing patience, he blurted, “George, you owe me big time for getting us out of there a lot earlier than we expected.”

At that point, wrote Bush, “I thanked him profusely. And I said nothing more. You cannot get mad at the guy. I admit to wondering why he can’t stay on time, but when I see him interacting with folks my wonder turns to understanding.”

At least once, however, Bush glimpsed a less endearing Clinton trait that was well known to his staff. Sometimes, when he felt things were going wrong, especially if he was fatigued or frustrated, Clinton blew up at Band, Cooper, and other staffers. Very rarely did this rage erupt in the presence of others—but just before their joint television interview on the Maldives, Bush had been startled by a loud burst of bad temper: “I heard him turn on his aide and take a huge bite out of his ass. It had to do with whether the mike for TV should go down through his shirt and out the bottom of the shirt or whether it could be hooked on the back. But at that juncture he was very tired.”

To anyone puzzled by the comradeship of Bush and Clinton, stock explanations about the unique bonding force of the presidency may not be persuasive. Few ex-presidents ever spent much time together, in fact, except on ceremonial occasions. Their bond was real, and unusual. Jon Meacham, the journalist and author who wrote an acclaimed Bush bi
ography, came to believe that his subject “was dazzled by Clinton’s gifts of gregariousness and charisma; [while] Clinton sought Bush’s fatherly approval and, given his historical imagination, enjoyed the company of this embodiment of the fading order of Cold War statesmanship.”

In early March, the pair of them returned to the White House to brief President Bush about their efforts. Praising them before a gaggle of reporters in the Oval Office, the president described their mission as carrying “our message of compassion” so the world might have “a different impression of America”—an allusion, perhaps, to global revulsion against the continuing carnage in Iraq. When he asked the former presidents to offer any comments, his father said, “My comment is President Clinton was a joy to work with.”

Clinton thanked the president for asking them to work together. The people they had seen, he added, “are very grateful for what the American military did, for what USAID did, for what the hundreds of non-governmental organizations have done. But there’s a lot of work left to be done, and we want to see it through to the end.”

The next day, Clinton and Bush flew down to a golf club in Hobe Sound, Florida, for a charity tournament hosted by former world champion Greg Norman. Returning to New York the next day, he headed straight to New York Presbyterian Hospital, where two surgeons finally performed the long-delayed decortication procedure to free his left lung from a band of rubbery scar tissue. Due to minor complications, the surgery took four hours to complete and was slightly more invasive than the doctors had originally planned. After twenty-four hours at the hospital he went home to Chappaqua for a month of recovery.

Clinton felt a distinct sense of satisfaction with the tsunami mission, though his work in the region was far from finished. Having agreed to represent the U.N., he would return to Indonesia, India, and Sri Lanka in May and again in November for meetings with Indian prime minister Manmohan Singh, among others, to monitor their progress, assess their needs, and try to prod peace talks forward. On that latter objective, he would find greater success in Aceh—where tsunami aid encouraged the separatist movement to sign a peace agreement with the Indonesian government in August 2005, under U.N. auspices—than in Sri Lanka, where the ongoing Tamil insurgency hindered reconstruction.

Whatever difficulties he confronted as U.N. envoy, the tsunami media blitz featuring Bush and Clinton achieved stunning results. In dollars raised, it proved to be the most successful private relief effort in history. While they would never seek any credit for that record, which obviously had required the efforts of millions, their leadership was important—and unprecedented in American politics.

A 2006 report by the Center on Philanthropy at Indiana University found that American individuals and families gave $2.78 billion for tsunami relief, with about a quarter of all households in the United States making at least one donation, often through churches, synagogues, mosques, or other religious institutions. Foundations and corporations donated another $380 million—and the former presidents had also bolstered public support for U.S. government spending of $950 million for relief and reconstruction. The world threw a large sum of money at the problems left by the tsunami, lending weight to the reconstruction slogan popularized by Clinton: “Build Back Better.”

Campaigning for tsunami relief with George H. W. Bush—at the behest of the Republican White House—endowed Clinton with the nonpartisan aura that his aides viewed as essential to a successful post-presidency. Much as he disagreed with the Bush administration on political issues, and articulated those disagreements, the president and his father had elevated Clinton to a position of respected statesmanship. Forgotten were the dark times when the Bush apparatus leaked slurs about purloined furnishings and encouraged prosecutors and politicians to investigate Clinton’s pardons. There was no more talk about restoring “honor and integrity” to the presidency, now that this old enemy of the first family had been transformed into an intimate friend.

So intense was the friendship between Clinton and the Bushes that it verged on the familial, with public references to Bill as “the fifth brother,” and speculation by the elder George and Barbara that he saw in his presidential predecessor the father he’d never had. “I love George Bush, I really do,” Clinton declared. Dubya called him “Bubba” or “the brother from another mother.” And the flinty matriarch, who had once declared her distaste for the Arkansan upstart in no uncertain terms, allowed that she had come to “really like” and even “love” Bill Clinton.

Partisan Democrats and Republicans alike found these expressions of affection more unsettling than uplifting. Newt Gingrich, who had proved susceptible to Clinton’s charm himself in years past, denounced the Bush family for “rehabilitating” the former president, and Gingrich wasn’t alone. On the other side, liberal Democrats believed that Clinton was providing political cover to a president whose policies they—and he—had consistently opposed.

Such caviling irritated Clinton, who insisted on his own political course, especially in dealing with the president. “I’m not the leader of the opposition anymore,” he retorted. “I will always be loyal to my party, but if I spent time being a leader of the opposition I wouldn’t be able to save lives doing what I’m doing. . . . That’s something we have to have Congressional leaders for, we have to have people like Hillary for, we have to have people like [then-Senator] Joe Biden and all these people who want to run for president—and I can be supportive, where it’s appropriate. But I have a different life now and I’ve got to lead it.”

The bipartisan Bush-Clinton rapprochement did not extend fully to Hillary. The Bushes said little about her publicly, and when her husband began to visit them occasionally in Kennebunkport, as he did that summer, she never joined him there. As a liberal Democratic senator who often criticized the Bush Republicans—and harbored presidential ambitions of her own—she may wisely have wished to avoid any photo opportunities at the exclusive Maine compound.

And that may have been why the elder Bush later told Meacham, “I don’t feel close to Hillary at all, but I do to Bill—and I can’t read their relationship even today.”

Bush, whose own marriage had suffered painful examination during his political career, was hardly alone in that observation. After years mostly apart, the Clintons’ marriage remained inscrutable even to longtime friends—an endless source of speculation in the media and among ordinary Americans. To cynics, it seemed to persist as some kind of political compact—but that didn’t explain why he constantly called her from abroad, or why she seemed breathless and even “coquettish” to staffers whenever he visited her Senate office.

For Bill Clinton, an invitation to spend more time with the Bushes arrived soon after he returned to New York—and he made the most of the opportunity.

On the morning of April 2, 2005, the Vatican announced the death of Pope John Paul II. When the White House invited him to join a small delegation to the pope’s funeral six days later, Clinton accepted—and departed for Rome from Washington on Air Force One with President Bush, his father, First Lady Laura Bush, and Secretary of State Condoleezza Rice.

Enjoying his first flight on the presidential aircraft since his departure from the White House, Clinton was suddenly summoned forward to Bush’s office in the front of the cabin. As soon as Clinton sat down, Bush snapped, “Tell me what you’re doing on AIDS. I want you to explain it to me. How do you relate to our program?”

The former president proceeded to describe the Clinton HIV/AIDS Initiative in some detail, focusing on its agreements with various countries—by then numbering in the dozens—and the generic manufacturers to provide low-cost medicine. And he was candid with Bush about the conflicts that had erupted early on between PEPFAR and CHAI.

“Well, in the first place it was terrible,” said Clinton, “because your people thought we were the enemies of the [branded] drug companies and they didn’t want to work with us at all in some of these countries.” He went on carefully. “I know what you’ve been told about these generic drugs, but just look at our results.”

Keenly aware of the pharmaceutical lobby’s access to the White House, he knew that the American manufacturers had persuaded the president and his appointees at PEPFAR that the generic formulations were so inferior that, rather than relieving illness, they would probably worsen the pandemic. Now he had a chance to persuade Bush to reconsider the administration’s hostility to his program.

“It’s going to make a big difference if you participate in this,” he pressed. “You could save a lot more lives for the money you’ve got.” Even with price reductions by the branded manufacturers, the generic program would provide at least four times as many doses for the same cost.

“Well, what am I supposed to do about this?” Bush asked plaintively. “I can’t ignore what these people are saying,” referring to the manufacturers’ warnings about the poor quality of the generic products.

Clinton tried a different tack. “How about this? What if we submit every single drug we buy from any of the other donors’ money to the
FDA for approval? If the FDA concludes—not for approval for sale in America, but if the FDA concludes they’re safe and effective, then you could say that in the countries where PEPFAR and CHAI operate together, if governments wanted to buy those drugs, then they could.”

Bush looked across his desk at Clinton for a moment. “That sounds fair,” he said. “I’ll do it.”

Outside pressures on the Bush administration to accept generic drugs for PEPFAR funding had been increasing steadily ever since the earlier clashes between Clinton’s program and the Republicans in Washington. In January 2005, a few months before Clinton and Bush conferred on the way to the pope’s funeral, the Government Accountability Office (GAO) had issued a harsh report on the issue.

Compiled during the course of a year’s research at the request of Senators Ted Kennedy and John McCain and Rep. Henry Waxman, the GAO report scathingly criticized PEPFAR’s refusal to approve funding for the kinds of generic formulations and two-drug and three-drug “cocktails” approved by the World Health Organization and purchased by the Global Fund and other major anti-AIDS initiatives in the developing world.

The yearlong study’s most important finding was that the United States government was paying far more than necessary by purchasing branded drugs from U.S. manufacturers, paying a big premium above the cost of generics. The excessive payments ranged as high as $368 per patient per year—which suggested that in total, PEPFAR was wasting huge sums of money by insisting on branded medicines. “Such differences in price per person per year could translate into hundreds of millions of dollars of additional expense, when considered on the scale of the plan’s goal of treating 2 million people by the end of 2008,” the report warned.

Slowly and reluctantly, the coordinators of PEPFAR had begun to accede to those pressures as early as the summer of 2004, when they agreed in principle to an expedited process for FDA approval of generic AIDS drugs. By early 2005 they had allow one generics manufacturer, South Africa’s Aspen Pharmaceuticals, to apply for FDA approval of two-drug formulations, which won approval more quickly than normal under the usual extended process. But it would be months and years before the U.S. government began to purchase substantial quantities of
generic drugs for distribution in PEPFAR target countries in Africa and the Caribbean—even though Bush aides argued that it had always been the president’s intention. After Clinton’s discussion with Bush, the approvals started to come more rapidly.

Meanwhile the Clinton HIV/AIDS Initiative was moving forward. Just over a week after Clinton’s conversation with Bush, he held a press conference in Harlem to announce a new $10 million pediatric treatment program, focused on providing care for children and especially infants, and preventing mother-to-child transmission of the virus during pregnancy.

To start, ten thousand children in ten countries—including China, India, Rwanda, Tanzania, Lesotho, and the Dominican Republic—would receive low-cost medications under an agreement negotiated between Ira Magaziner and Cipla, the Indian generics manufacturer, which had agreed to reduce the prices of a special medicated syrup and child-sized pills by half. CHAI would spend $2 million on the drugs and another $3 million to support clinics where the program would train local medical personnel to oversee treatment.