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Bill Clinton at a Clinton Foundation event, 2015
Bill Clinton at a Foundation event on January 26, 2015.
Earl Gibson III/WireImage

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The key question on the Clinton Foundation is whether it saved lives. The answer is clearly yes.

Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

Hillary Clinton’s campaign and her allies have so far offered a simple defense of the Clinton Foundation — which Donald Trump, Republicans, some left-wing critics, and much of the press have characterized as a giant pay-for-play scam that the wealthy and powerful used to gain access to the Clintons.

The Clintonites assert there’s simply no evidence of a quid pro quo, no evidence of favors being given by Clinton to foundation donors. On the contrary, according to reporting thus far, the evidence that exists is of such favors being requested and denied. When foundation staffer Doug Band tried to use his ties to Hillary Clinton aide Huma Abedin to get a diplomatic passport for himself, he was rebuffed. When he tried to get a visa for a British soccer player, Abedin said the request made her nervous, and Band backed off.

"The fact remains that Hillary Clinton never took action as Secretary of State because of donations to the Clinton Foundation," campaign spokesperson Josh Schwerin told the Washington Post.

"Hillary Clinton doesn't have a conflict of interest with charitable work," campaign manager Robby Mook asserted on MSNBC’s Morning Joe. "That's all it is."

But some Clinton surrogates have tried a different approach: focusing on what the foundation does, rather than what it didn’t do. In August, Clinton loyalist James Carville told CNN’s Anderson Cooper that if the press succeeds in getting the foundation shut down, "There will be people that are going to die because of this."

"The foundation negotiated drugs prices to reduce malaria drug prices by 89 percent," Carville said. "The Clinton Foundation was taking no money for the Clintons, raising money from rich people and giving it to poor people. … All of the people that helped shut it down will say, some people, a million people, had to die, but we had to prove a point."

Carville’s argument raises the question we should be asking about the Clinton Foundation: Is it a good charity? If the Clinton Foundation really is saving millions of lives, then that’s the story — not what favors Band asked for, but didn’t receive, from Huma Abedin. But if the Clinton Foundation was a poorly run vanity project where Bill Clinton traded on his celebrity while merely pretending to help the needy, then that’s a genuine scandal given the billions of dollars that passed through its coffers.

Effective philanthropy is something I’ve spent a lot of time thinking about and reporting on, and so that’s the question I set out to answer: Does the Clinton Foundation do worthwhile charitable work?

My starting point, to be honest, was skepticism. Most elite charitable giving is terrible, more a vehicle for wealthy donors’ self-aggrandizement than actual change. Donors tend to select causes that are trendy and thus oversaturated with funders as is, or to give to famous organizations regardless of merit. Even when they pick a good cause, like global poverty, screw-ups are common.

Take the PlayPump, a charity fad from the mid-2000s in which merry-go-rounds were attached to water pumps in African villages. The goal was to make it easier to access clean water. The project was catnip to clever design–obsessed philanthropists. Donors loved watching cheerful kids play their way to cleaner water. But when the cameras left, it turned out children were being forced to toil on the playground for hours on end.

I thought it was likely the Clinton Foundation had gotten behind a lot of PlayPump-like projects — feel-good, sound-great ideas that attracted Clinton’s wealthy and well-known friends but didn’t really have much of a measurable impact the world.

But I was wrong. After reviewing foundation documents and talking to numerous people in the philanthropy and global health sectors familiar with its work, I’ve come to the conclusion that the Clinton Foundation is a real charitable enterprise that did enormous good. Its projects are of varying effectiveness, but its work is supported by credible, discriminating funders, and the foundation has least one huge accomplishment under its belt — an HIV/AIDS program that saved an untold number of lives.

And — perhaps uncomfortably for liberals and conservatives alike — it is exactly the kind of unsavory-seeming glad-handing and melding of business and politics for which Bill and Hillary Clinton have taken years of criticism that led to its greatest success.

The Clinton administration’s failures set the stage for the foundation’s breakthrough win

AIDS activists protest Al Gore in 1999
Activists Jennifer Smith and Johnathan Burger with the HIV and AIDS Treatment Action Campaign tear fake US money bearing the portrait of Al Gore during a protest on August 23, 1999, in Washington, DC.
Tim Sloan/AFP/Getty Images

The Clinton Foundation’s biggest victory was born of one of the Clinton administration’s greatest failings.

The AIDS epidemic had been going on for more than a decade when Bill Clinton took office. During his eight years in the White House, HIV/AIDS went from a death sentence to a manageable condition that patients could live with for decades — at least in rich countries like the US.

The game changer was an approach known as highly active antiretroviral therapy (HAART), introduced in 1996. Antiretrovirals (a category of drugs that target retroviruses, the type of virus that includes HIV) had been used against HIV since the drug AZT was approved as a treatment in 1987. But HAART combines three antiretrovirals into a "triple cocktail," creating multiple obstacles for the virus and preventing it from replicating far more effectively than a single drug alone could.

At the same time HAART was revolutionizing HIV/AIDS treatment in the US, the AIDS epidemic began to tear through developing countries, particularly the sub-Saharan region of Africa. The tone of press coverage in the late ’90s and early ’00s suggested the whole continent was on the verge of a Black Death–scale catastrophe. A Newsweek cover story in January 2000 anticipated "10 million AIDS orphans." The writer, Tom Masland, elaborated: "Before the current epidemic, the perennial cataclysms of war and famine orphaned 2 percent of the region's children; AIDS makes that figure look benign."

NGO heads were also prepared for apocalypse. The World Bank vice president for Africa, Callisto Madavo, told the Village Voice's Mark Schoofs in 1999 that in the worst-hit African countries, life expectancy "will soon be 17 years shorter because of AIDS — 47 years instead of 64 … [HIV] is quite literally robbing Africa of a quarter of our lives."

Schoofs went further: "Quite simply, AIDS is on track to dwarf every catastrophe in Africa's recorded history." Schoofs, who won a Pulitzer for his reporting on the epidemic, noted that the three-drug therapy available in the US could save millions of lives if deployed to Africa, but despaired at the high cost.

"These regimens must be taken for years, probably for life, and they can cost more than $10,000 per patient per year," he noted. "Even at discounted prices, the annual cost of putting every African with HIV on triple combination therapy would exceed $150 billion, so the world is letting a leading infectious killer for which treatment exists mow down millions."

The main reason HIV drugs were so expensive was that they were patented and pharmaceutical companies set the prices high; cheap, generic competitors were banned. There was a catch, however: Not every country respected US and European patent law.

India had, for decades, banned patents on pharmaceutical chemicals, and the Indian generics company Cipla had been reverse-engineering AIDS drugs since 1992. The company had a triple-cocktail option soon after it was introduced in the West. At the time, India had signed on to TRIPS, an agreement of the World Trade Organization that obligated signatories to obey US-style intellectual property law, but because of India’s relative poverty, the country was allowed to defer implementation of the agreement until 2005. That gave generics companies a decade to become leaders in supplying cheap HIV drugs.

In 1997, South Africa, facing HIV infection rates of close to 20 percent, decided to start taking advantage of the lower prices from Cipla and other Indian generics companies. The country passed a law seeking to access generics through two policies: first, parallel importation, which let it import generics from countries like India where they might be cheaper, and second, compulsory licensing, which lets generics manufacturers produce patented drugs and compensates the patent holder for the IP violation at a dramatically reduced rate.

Pharmaceutical companies went ballistic — and the Clinton administration backed them up. Thirty-nine drug companies sued South Africa to block the new policy. The US Trade Representative put South Africa on a "watch list" of intellectual property violators and withheld normal trade benefits for a number of South African products. Al Gore, the administration’s leading voice on South Africa, told then-President Nelson Mandela that the US would not allow the legislation to go forward. It probably didn't hurt pharma's cause that the White House deputy and then full chief of staff at the time was John Podesta, whose brother Tony was the industry's top lobbyist in DC.

Effectively, Clinton was using the full weight of the US government to make it harder for HIV patients in South Africa to get treatment even though it was suffering sky-high infection rates.

This prompted an international backlash from AIDS activists who were horrified to watch the US government fight drug affordability in a poor country hit hard by the epidemic. Gore, who was in the middle of running for president, was an important target. Protesters repeatedly interrupted rallies in 1999 by chanting, "Gore’s greed kills!" The activist campaign in turn spurred members of the Congressional Black Caucus like Reps. Jesse Jackson Jr. and James Clyburn to put pressure on the White House to reverse course.

And so Clinton flip-flopped under pressure. In September 1999, the US Trade Representative and the South African government announced that the fight was resolved and the US would stop pressuring South Africa on the matter; it would be free to attempt to get generic drugs without penalties from US trade officials.

President Clinton issued an executive order in May 2000 stating, "The United States shall not seek, through negotiation or otherwise, the revocation or revision of any intellectual property law or policy of a beneficiary sub-Saharan African country […] that regulates HIV/AIDS pharmaceuticals or medical technologies." Later, during the Bush administration, this policy went global. At its 2001 Doha meeting, the WTO agreed to delay implementation of TRIPS in poor countries and give countries more flexibility to use compulsory licensing and other methods to bring down prices of drugs needed to address emergencies like the AIDS epidemic.

This was the Bill Clinton record on HIV/AIDS as president: years of standing behind drug companies and offering little US aid in the face of the crisis, followed by a late-breaking flip-flop. It was a moral stain on his administration.

A brief history of the HIV/AIDS drug price drop

Just as Clinton was leaving office, something remarkable began to happen to the price of HIV/AIDS drugs: They started to fall. A lot.

In 2000, the cost of the cheapest brand-name three-drug combo was about $10,439 per year — manageable for US insurers but simply untenable in poor countries. A year later, the cheapest brand-name combo was running about $727 a year. And then it just kept falling further:

HIV combo drug prices, from 2000 to 2011.
HIV combo drug prices, from 2000 to 2011.
Médecins Sans Frontières

This price drop had two initial sources, according to Tamara Mann Tweel, a Columbia researcher who’s studied it in depth.

First, pharmaceutical companies, facing intense public relations pressure, began to offer huge discounts for pilot projects in poor countries. This was not an act of altruism — the companies still turned a small profit on the sales and managed to boost their corporate reputations.

Second, activists like Jamie Love of the Consumer Project on Technology (now known as Knowledge Ecology International) pushed for and won a change in WTO rules that let generic drugs be sold more broadly. They attempted to negotiate down prices by attempting to match generics manufacturers with NGO funders who could buy in bulk.

By 2000, Cipla was offering a combination one-pill therapy containing all the drugs in the cocktail. But it didn't have sufficient demand. Love brokered a deal between Cipla CEO Yusuf Hamied and Doctors Without Borders (MSF) wherein Cipla would provide the drugs in bulk — for only $350 a year per person, or about $1 a day. This was a dramatic reduction even from generic prices, but Cipla would still be able to turn a profit provided MSF paid in cash and took care of distribution.

Once the $1-a-day offer demonstrated that mass purchases of AIDS drugs could be done affordably, institutions capable of financing bigger buys than MSF sprouted up. One was the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a public-private partnership formed in 2002 and funded by governments like the US and foundations like the Bill & Melinda Gates Foundation. Another was the US President's Emergency Plan for AIDS Relief (PEPFAR), a massive expansion of AIDS funding pushed by George W. Bush's administration. Later on came UNITAID, a project of the governments of Brazil, Chile, France, Norway, and UK that funds global health measures through a tax on airline tickets.

Those institutions provided the money necessary to purchase and distribute vast quantities of generics, taking advantage of the price reductions that activists like Love had achieved.

The Clinton Foundation’s role in the price drop

Bill Clinton and South African President Thabo Mbeki meeting in 2000.
Clinton and South African President Thabo Mbeki meeting in 2000.
Tim Sloan/AFP/Getty Images

It’s here — after the price drop to $350, and after the extensive work of activists who once opposed his administration — that Bill Clinton enters the picture.

In 2002, only a year after leaving office, Clinton decided to make reducing the cost of HIV/AIDS drugs his first project at the Clinton Foundation. He formed the Clinton Health Access Initiative (CHAI), a division of the foundation that housed the group’s work on public health, and tapped his old Rhodes Scholar buddy Ira Magaziner (who had become famous, or infamous, for his role in the failed Clinton health reform push of 1993-’94) to run the operation.

Specialists in the field were understandably skeptical of a president who’d failed to tackle the epidemic when he wielded the power of the presidency suddenly adopting the cause. Former Harvard School of Public Health dean Howard Hiatt asked Clinton at a meeting at the foundation in 2002 why he and other attendees should expect "you’ll be able to accomplish now what you didn’t undertake in your presidency — an attack on this plague?"

But Magaziner and CHAI had a plan — one that relied on Clinton’s unique celebrity and ability to bring foreign leaders and pharmaceutical CEOs to the table in the way an ordinary civilian couldn’t. This was the whole idea behind the Clinton Foundation. At the time, Clinton himself wasn’t wealthy enough to influence things solely as a funder. But what he lacked in money he made up for in an extensive Rolodex and unparalleled glad-handing skills. And in HIV/AIDS drugs, he thought he’d found a problem that those resources could help solve.

The HIV/AIDS drug market, CHAI argued, was still not functioning correctly. PEPFAR and the Global Fund were still getting set up, and the former was initially required to pay for brand-name drugs. CHAI’s theory was that prices could be brought down still further by banding developing countries together and having them act as a purchasing unit that could bargain with generics manufacturers. Initially they tried to do this with US and European drug companies, and met with little success, and so moved on to Indian and South African generics companies.

CHAI’s basic approach was to ask drug companies to accept smaller margins in exchange for higher volumes. "In essence, CHAI negotiations helped transform the business model for the ARV industry," political scientists Ethan Kapstein and Joshua Busby write in their history of the global AIDS activist movement, AIDS Drugs for All. Previously, even with prices as low as $350, companies like Cipla and its competitor Ranbaxy were selling at relatively low volumes but with healthy margins. The goal of CHAI was to transform the sector into a lower-margin, higher-volume industry.

In an interview with the Atlantic’s Jonathan Rauch, Bill Clinton put the change this way: "What we tried to do was to get them to go from what I call a ‘jewelry-store model’ to a ‘grocery-store model’—from a high-profit, low-volume, uncertain-payment business to a low-margin, high-volume, certain-payment business."

Many of these developing country governments were led by politicians with whom Bill Clinton had personal relationships from his time as president. "My sources at CHAI often remarked that CHAI’s ability to work with governments and their health ministries led to the most sustainable form of change," Mann Tweel writes. "It made governments commit to purchasing the drugs while helping them build the infrastructure for sustainable treatment."

One of the most striking features of the first deal CHAI cut was the inclusion of South Africa as one of the bargaining nations. For years, South African President Thabo Mbeki had stalled on providing access to HIV drugs because he subscribed to discredited pseudoscience alleging that HIV doesn’t cause AIDS.

Clinton appears to have personally played a role in getting Mbeki, whom he got to know when their presidencies overlapped in Clinton’s last years in office, and his government to join the price negotiations. In July 2003, Clinton attended Mandela's 85th birthday party in Johannesburg, and during the dinner he pulled Mbeki away to discuss his AIDS response. Per New York magazine’s Jennifer Senior:

Two years ago, at Nelson Mandela’s 85th-birthday party — a 1,600-person extravaganza whose guest list included everyone from Bono to F. W. de Klerk — Clinton and Thabo Mbeki, the current president of South Africa, got up in the middle of the festivities, trailed by [CHAI president Ira] Magaziner. "They just … walked out," recalls Richard Holbrooke, the former U.S. ambassador to the U.N. "And went into a private room." They returned half an hour later. It was after that meeting that Mbeki, famously reluctant to even acknowledge that HIV caused AIDS, agreed to allow the Clinton Foundation to assist his government in preparing an AIDS-treatment plan. (It was adopted by the Cabinet the following November.)

The victory was hardly complete; Mbeki later reversed himself and rejected a team Clinton sent in 2004. Clinton soldiered on, and CHAI eventually did build a South Africa operation, but Mbeki kept CHAI’s operations from growing too much. The group’s involvement in the country grew dramatically after Jacob Zuma succeeded Mbeki in 2009.

"The health ministry had never fully welcomed CHAI," journalist Joe Conason concedes in Man of the World, his very positive account of Clinton's post-presidency. "By 2009, only 700,000 people were on treatment there." But Clinton’s glad-handing appears to have meaningfully moved the needle at least somewhat, turning one of the most intransigent opponents of action on HIV/AIDS in Africa into an occasional, if unreliable, ally.

Clinton’s personal touch was also influential in getting buy-in from generics manufacturers. When CHAI was getting started, Conason reports, Clinton sent personal letters to generics company CEOs in India explaining his plan and urging them to join the initiative. His track record as president helped gain their trust: "No doubt his restoration of good diplomatic relations with India as president and subsequent work with Indian American business moguls on disaster relief were helpful," Conason notes.

One obvious question this raises is whether the price drop could’ve happened without the explicit bargaining CHAI did. If these developing countries were going to start putting in orders anyway, that increase in demand should’ve prompted generics companies to produce more, to start benefiting from economics of scale, and to then cut prices to maintain an edge over one another. In a properly functioning market, that’s what would have happened.

The argument CHAI staffers make is that the international generics market at that time was poorly functioning, and even if it could have organized itself better in time, that delay would’ve meant thousands, if not millions, of HIV-positive people going untreated. Instead, they got treatment because CHAI brokered cheaper prices sooner.

Analysts across the board tend to give CHAI and the Clinton Foundation credit for its role in helping rationalize the market. "CHAI successfully intervened in a transforming market," Mann Tweel concludes. Busby, the political scientist, tells me his and Kapstein’s research convinced them that "CHAI was essential for organizing the market for AIDS drugs in the early days both on the demand side and the producer side."

Love, the activist who was key to the generics-based price drop, is more skeptical, saying, "CHAI and others have often distorted view of the CHAI and drug company role in lowering drug prices." But all the same, he grants that CHAI "helped people do some more coordinated procurement" and "has played an important role in the rollout and scaling of treatment of HIV/AIDS in developing countries."

This is reflected in the actual pricing data. From 2002 to 2007, purchasers bought drugs both at CHAI-negotiated prices and through non-CHAI channels. One study found that prices for CHAI drugs during that period were 6 to 36 percent lower. That’s a strong indication that CHAI pushed prices below where they would’ve been had it never existed.

And crucially, CHAI’s victory appeared to hinge strongly on the very dynamics that make people uncomfortable about the Clinton Foundation. The deals made required buy-in from developing governments. The person tasked with getting that buy-in was a former US president with existing relationships with many of those people. Bill Clinton essentially used his chumminess with foreign politicians and pharmaceutical executives, the kind of thing about the Clinton Global Initiative that earns suspicious news coverage, to enlist their help in a scheme to expand access to HIV/AIDS drugs.

Larry Chang, an associate professor of medicine at Johns Hopkins who has worked on global HIV/AIDS response for the past two decades, singles out "the convening power of Clinton" as a key factor in getting the price reduction done. As Rauch put it in the Atlantic, "It seems unlikely that anyone but a Clintonesque political celebrity could have persuaded disparate, disorganized AIDS-drug makers and governments to join hands."

The foundation is still doing important work in global health

Bill Clinton visits the Butaro Cancer Center of Excellence in Rwanda.
Bill Clinton visits the Butaro Cancer Center of Excellence in Rwanda.
Clinton Foundation

The Clinton Foundation’s role in the price drop is undoubtedly its biggest single victory. Now that that’s finished, would we really miss the foundation that much?

Global health researchers seem to think we would. It’s stayed active on HIV/AIDS and other infectious disease issues, and has notched similar wins. After the price drops, it hired scientists and built up technical capacity to help develop cost-saving alterations to drug formulae. In 2011, CHAI, with funding from the Gates Foundation and the UK government, and in collaboration with Howard University, developed a new way to synthesize the antiretroviral tenofovir, which lowered production costs by 20 percent.

It has also played a role in the direct distribution of ARVs. Laura Seay, a political scientist at Colby College who was doing dissertation research in the Democratic Republic of the Congo in the mid-2000s, recalls the Clinton Foundation as one of the only NGOs willing to provide AIDS treatment in the country, given ongoing violence. In conjunction with local partners and the group Global Strategies, she says, "The Clinton Foundation decided to provide the first pediatric AIDS treatment in the region."

"I found it really powerful work. You have to remember at that time, across the border in Rwanda or Uganda, if you had HIV, it wasn’t hopeless, like it had been five or six years before," she explains. "The Clinton Foundation negotiated the prices down and got the generic access that was needed to extend that to millions of people but that had not reached into places that were dangerous and where there was a risk of rebels coming in. But they decided to take the risk."

"I saw kids who in the space of two years went from skin and bones to being healthy and thriving children who could go to school and have a good life," she continues. "It was because of the Clinton Foundation, and because they weren’t afraid to give it a try."

For funding rollout efforts like this, Bill Clinton’s personal charm again played a role. In 2003, Schoofs reported that Clinton "secured partial funding by personally lobbying leaders of rich nations, such as Ireland and Canada." Clinton told Schoofs, "Usually I just call the prime minister or the president, and tell them what we're doing and ask them to have somebody look at it. And I always tell them that even though we're friends they don't have to do this for me — don't do it unless they think it's a good thing. But I think it's the best thing going in the world in AIDS care."

Clinton’s personal ties also helped created a major funding stream for HIV/AIDS programs. In AIDS Drugs for All, Kapstein and Busby note that UNITAID was originally meant as a legacy project for French President Jacques Chirac. He wanted to use airline levies to fund something related to international development, but he wasn't sure what.

The French foreign minister, Philippe Douste-Blazy, "stumbled on" a destination for the money "after meeting with Bill Clinton in 2005," Kapstein and Busby write. "Clinton told him he should work on HIV/AIDS and said, 'You have to say to the drug companies, I'm giving you money, not for one year but for several years, for example, three hundred million dollars per year for five years. How much do you agree to decrease the price?'"

CHAI continues to play a price-negotiation role, both for drugs targeting other diseases (it has achieved similar deals on malaria medication and for a variety of vaccines) and on HIV/AIDS. Chang, the Johns Hopkins doctor, notes that CHAI has been active in trying to lower the price of viral load testing, an important diagnostic tool for seeing if patients are responding well to ARV treatment.

Perhaps the best argument for the value of CHAI’s work comes from its donors. The Gates Foundation, which is known for rigor in grant determinations, gave CHAI and other Clinton Foundation initiatives more than $67 million in 2015 alone. UNITAID has donated over $25 million. These are not groups known for frivolously throwing money around. They’re serious players in a variety of global health domains, which have decided to pour meaningful funds into the Clinton Foundation.

The Foundation’s non-health activities are smaller in scale, with some notable failures

Bill Clinton speaks at the opening ceremony of the Marriott Port-Au-Prince, Haiti
Bill Clinton speaks at the opening ceremony of the Marriott Port-au-Prince.
Hector Retamal/AFP/Getty Images

While global health has been the crown jewel of the Clinton Foundation — so much so that CHAI was eventually spun off to become its own separate, but connected, group in 2010 — the foundation has a variety of other projects, tackling causes ranging from obesity prevention and opioid addiction in the United States to climate mitigation and adaptation to a variety of economic development efforts in Haiti. The foundation’s cause selection is notable in its heavy emphasis on global development, a relatively neglected area by many foundations, which tend to be more US-focused.

But these activities make up a relatively small share of the foundation’s work in pure monetary terms. In 2014, fully 57.3 percent — some $143 million — of the Clinton Foundation's spending went to the Clinton Health Access Initiative; that’s nearly two-thirds of all non-administrative and fundraising spending. Another $23 million went to the Clinton Global Initiative events, and another $13 million after that to the Clinton Presidential Center, Clinton's presidential library in Arkansas.

The Clinton Climate Initiative accounted for only 3.3 percent of the foundation's expenses; the Clinton Health Matters Initiative, its US-based health program, only 1.5 percent. Perhaps because they are funded by a relatively small slice of the foundation’s revenue, which is then itself spread thin across a variety of distinct projects, these endeavors haven’t yielded the high-profile victories that CHAI has.

But there has been one high-profile failure: the foundation’s work in Haiti following the country’s devastating 2010 earthquake. Jonathan Katz, a veteran Haiti reporter who has done excellent coverage on the foundation’s programs there, argues, "The Clintons made the same mistake that has been made for generations. Though striking a populist pose, in practice they were attracted to power in Haiti, which meant making alliances and friendships within the Haitian elite."

That led to projects like luxury hotels that appeared to help foreign investors more than average Haitians. It also led to the Clinton effort’s most high-profile failure: the $300 million Caracol Industrial Park, an effort to build a center for garment exports in the north of Haiti. The project promised 100,000 jobs, including 60,000 within five years of its opening, many through its primary tenant, the South Korean clothing manufacturer Sae-A. As of last spring, fewer than 5,500 people were employed at Caracol.

"That comes out to roughly $55,000 in investment per job created so far," Katz writes. "Or, to put it another way, about 30 times more per job than the average Sae-A worker makes per year." And the focus on Caracol in the north distracted from the task of rebuilding Port-au-Prince, the capital that was hit particularly hard by the quake.

The failure there is tragic. But the Clinton Foundation’s failed Haiti development project certainly wasn’t the country’s first, and it’s likely not to be its last.

Compare the Clinton Foundation to the Trump Foundation

Hillary Clinton and Melinda Gates at the 2014 Clinton Global Initiative annual meeting.
Hillary Clinton and Melinda Gates at the 2014 Clinton Global Initiative annual meeting.
Stephen Chernin/AFP/Getty Images

In light of the Clinton Foundation and CHAI's accomplishments, it's surreal to read the way the organization is covered, not just in anti-Clinton press outlets but in mainstream ones.

The New York Times’s Eric Lichtblau frets over "new questions about whether the charitable foundation worked to reward its donors with access and influence at the State Department." The Wall Street Journal’s Peter Nicholas and James Grimaldi darkly warn, "Hillary Clinton as secretary of state attended high-profile events and functions where donors to her family’s charitable foundation were in attendance, calendar records show." The Associated Press’s Stephen Braun and Eileen Sullivan, in a deeply flawed report fretting over Clinton’s record of meeting with prominent development economists and NGO leaders who also donated to the foundation, warn, "[A] Clinton administration would have to take careful steps to ensure that past foundation donors would not have the same access as she allowed at the State Department."

Such stories have prompted opponents, from Trump to Karl Rove, to urge the Clinton Foundation to "shut down" already.

This debate has become representative of how the Clinton Foundation is covered more broadly. The value of the organization is almost entirely divorced from actual charitable programming. Stories about the foundation don’t mention what the money that allegedly bought this access was spent on. They don’t distinguish between giving to the Clintons, personally, and giving to their charitable organization.

Meanwhile, Hillary Clinton’s opponent runs a foundation that is very clearly a scam, which used tax-exempt funds to purchase an autographed Tim Tebow helmet and a giant portrait of Donald Trump.

The media has botched this story. The amount of ink spilled on as-yet-unsubstantiated insinuations that the Clintons sold access through their foundation, as opposed to the foundation’s actual lifesaving work in public health, is ludicrous.

There is little to no evidence that anyone received meaningful favors from the Clintons in exchange for donating to the foundation. There is definitely no evidence that Hillary Clinton altered her policies as secretary of state in reaction to donations. There’s no evidence that the Clintons or their foundation engaged in some of the more egregious activities of Trump’s foundation, like donating to a state attorney general to deter her from an investigation into Trump’s activities, or giving to a nonprofit to fund a lawsuit against another state AG who did opt to investigate, or even paying off the legal bills of his for-profit businesses.

But there is considerable evidence that the Clinton Foundation has saved millions of lives. And there’s evidence that Bill Clinton’s work with the group would make him more useful as first spouse. Presidents rely heavily on special envoys tasked with making deals to resolve prisoner disputes, facilitate peace processes, and the like. Clinton’s time with the foundation exhibited the exact set of skills necessary for a role like that. His presence could greatly expand the diplomatic bandwidth of his wife’s administration.

The fact that Hillary Clinton’s association with a group, and a husband, with that track record has become a liability rather than an asset is a deep indictment of how skewed the press’s priorities in covering this election have become.

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