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The AIDS Bureaucracy.

The AIDS Bureaucracy. Sandra Panem. Harvard University Press, $22.50, cloth; $295, paper The government's health care bureaucracy couldn't handle AIDS because of structural flaws, Panem writes. Had the flaws not existed, the government could-and would-have contained AIDS.

No one denies imperfections in the Public Health Service, the Centers for Disease Control, the National Institutes of Health, and the Department of Health and Human Services, There is, for instance, little systematized cooperation between the epidemiologists at CDC and the research scientists at NIH, and frequently there's a great deal of tension. These government agencies are illequipped to react quickly to a health emergency. (There isn't even a clear definition of what constitutes such an emergency.) To solve these and other problems, Panem, a science writer, proposes a number of remedial steps: the establishment of an AIDS "czar"; "generous and centralized finances"; central oversight of research; longterm strategic planning, and others.

There's nothing wrong with any of these recommendations. But even if they were all instituted today, they wouldn't solve the problem. In focusing on bureaucratic snags, Panem misses a larger point. It wasn't solely because of a flawed bureaucracy that the Reagan administration bungled AIDS. The administration failed to really mobilize against AIDS because in the early 1980s, when the disease's spread could have been slowed, it didn't want to. To begin with, the administration was cutting funds for health services in general. And with the possible exception of its surgeon general, C. Everett Koop, the administration never had Mother Teresa-like sympathy for the homosexuals and drug addicts most stricken by AIDS.

It's a mistake to write of the health system, as Panem does, as if it functions in a vacuum. Bureaucracies are inherently political, They need leadership to move. With AIDS, they didn't get it. -Richard Blow
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Author:Blow, Richard
Publication:Washington Monthly
Article Type:Book Review
Date:Oct 1, 1988
Words:298
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