Feature

Afghanistan Is the New Afghanistan

Twenty years ago, the Soviets cut their losses and withdrew from Afghanistan. If it wants to avoid that outcome, the United States should learn its history.

In a recent ForeignPolicy.com article, Thomas Johnson and Chris Mason argue that Afghanistan is the new Vietnam. They are right, but there is another historical parallel which is both more obvious and less discussed: the Soviet involvement in Afghanistan.

U.S. government officials have understandably avoided the comparison. For one, the United States supported the other side: Afghan "freedom fighters" who later became enemies. Further, the Soviets became bogged down in a costly and bloody decade-long quagmire before Soviet leader Mikhail Gorbachev ultimately pulled the plug and withdrew. Moscow's invasion of Afghanistan and its attempt to create a working central government in Kabul is broadly (if somewhat inaccurately) deemed a failure.

It's a failure the United States apparently has no intention of repeating -- to the extent that it doesn't even seem to study it. The U.S. Army/Marine Corps Counterinsurgency Field Manual does not mention the Soviet experience once. One analyst told me that when she suggested including the conflict as a way to inform current policy, Pentagon officials seemed to have little awareness about what Moscow had been trying to do there or for how long.

But the United States has much to learn from the Soviet invasion and occupation of Afghanistan. Of course, there are vitally important differences. The United States has Pakistani support, while the Soviets did not. No superpowers back the Taliban now, but the United States supported the insurgents then. American forces are now fighting a distant war, but Afghanistan was proximate to the Soveit Union. And global networks like al Qaeda now fund insurgency in Afghanistan, but barely existed in the 1980s. Still, the similarities are worth considering.

When the United States helped topple the Taliban in the heady days after the September 11 attacks, the plan was to get Osama bin Laden and establish a democratic, pro-American government.  No one planned on an eight-years-and-counting presence that would cost 800 U.S. lives, tens of thousands of Afghan lives, and half a trillion dollars.

Similarly, when Soviet leaders decided to invade Afghanistan in 1979, they did not intend to commit hundreds of thousands of troops over a decade to fight a domestic insurgency. They hoped that while Soviet troops provided training and logistical support to the military of the Democratic Republic of Afghanistan, economic aid and a massive advising effort would help build up the governing ability of the main political party. The Kabul government would then have the legitimacy and defense capability to stand on its own two legs without Soviet troops. Leonid Brezhnev, the Soviet leader at that point, seems to have genuinely believed that soldiers would be home within a few months.

In practice, of course, things did not quite work out that way. Much like the efforts of the United States and its allies -- building schools without teachers to man them and promoting farming in desertlike areas where nothing grows -- the Soviet attempt at nation-building suffered from poor coordination, ill-planning, and a misunderstanding of indigenous culture. Moscow informed soldiers they were not in Afghanistan to spread communism, but to help people feel the tangible benefits of a working government. Still, enthusiastic party workers drew on Soviet propaganda and organizing principles, often alienating the local population.

These problems were compounded by rivalries among various Soviet agencies and institutions operating on the ground. Aid sometimes did not reach its destination because military commanders refused to relinquish the necessary transport vehicles or provide security. In other cases, Soviet representatives found that their Afghan "clients" had no intention of playing along with their nation-building plans. On one occasion, the KGB cultivated and promised protection, money, and a house to the leader of an insurgency group. The local governor, in turn, promptly denied the insurgency leader the promised housing and seized the cell's weapons.

Likewise, though the Afghan military looked strong on paper, with more than 300,000 men and a generous supply of Soviet weaponry, it proved incapable of leading offensive operations. Within several months Soviet troops were fighting the insurgency directly, while Afghan forces did not take the lead in an operation until 1986. The complaints of Soviet officers working with Afghan troops would sound familiar to U.S. and NATO officers today. Recruitment proved difficult. Desertions were rife. Corruption was widespread. Troops avoided going into battle for fear of retribution against their families.

The broader security and occupation dilemma was familiar as well. The Soviet military was perfectly capable of clearing an area of insurgents, albeit not without significant collateral damage. But Moscow never sent enough troops to keep those areas free of insurgents once an operation was completed. There were never more than about 108,000 Soviet troops operating in Afghanistan at any given time.

Sending in reinforcements was rejected for a number of reasons. For one, it would have risked further angering the local population. Additionally, it would have fueled the already significant criticism of the Soviet Union, both from the West (the United States boycotted the 1980 Olympics and enacted an embargo on grain) and developing countries (who supported a U.N. resolution denouncing the invasion and calling for withdrawal). It also would have made the war much more difficult to keep hidden at home. Remarkably, the Soviet press was largely forbidden from mentioning that troops were engaged in combat.

Finally, in both cases there was a misunderstanding of the country's ethnic politics. In 1979, Moscow installed Dari-speaking Babrak Karmal as leader, despite his weak ties to the country's Pashtuns. In 1986 it replaced him with Mohammed Najibullah, who highlighted his Pashtun heritage and cultivated strong ties within his ethnic bloc. But Moscow's overreliance on Najibullah undermined efforts to reach out to the country's other groups and leaders, such as powerful Tajik warlord Ahmad Shah Massoud. Similarly, the dominance of non-Pashtuns since the U.S. invasion has alienated Pashtuns, traditionally Afghanistan's elites.

Thus, U.S. President Barack Obama is in a situation surprisingly similar to the one in which Gorbachev found himself when he took power in 1985. Recognizing the Afghan war's utter mismanagement, the last Soviet leader worried about what retreat -- failure -- would mean for his country's prestige, its security, and his own political survival. Gorbachev decided quickly that he had to replace corrupt and ineffectual Karmal with someone who could hold together the fractious Kabul regime and reach out to insurgents. Although his first year saw a minor "surge" of military activity, ultimately Gorbachev abandoned the nation-building effort and brought Soviet troops home, meanwhile focusing his efforts on trying to find an international settlement.

The Soviet intervention was disastrous in many ways. But if there is a hopeful historical lesson, it is that Moscow neither won nor lost in Afghanistan. After Soviet troops went home in 1989, the Najibullah regime survived for three years, without any more Soviet soldiers laying down their lives. The Afghan army proved just strong enough to hold its own. Where it could not or would not, militias paid by Kabul did the job. Had the Soviet Union not collapsed, the regime in Kabul might have grown and survived indefinitely.

So far, the Obama administration appears to have no interest in doing what Gorbachev did and cutting its losses. It has embarked on a military and a civilian surge, bulking up the Provincial Reconstruction Teams and involving more aid workers. Administration officials still believe that a stable, democratic Afghanistan is a possibility. But if they ultimately decide to settle for a less ambitious outcome, the Soviet experience suggests that it might not be that bad.

Daniel Janin/AFP/Getty Images

Feature

Brazil's Public Option

What Obama can learn from Lula about universal health care.

Brazil's place as one of the "BRIC" emerging powers has never been in question since the term came into use in 2001. Under the leadership of President Luiz Inácio Lula da Silva, the country has emerged as a diplomatic power and the region's clear economic leader. It also happens to be one of the few countries in the Western Hemisphere with universal health care. As U.S. President Barack Obama strives to pass health-care reform in the coming weeks, he would do well to examine the praiseworthy successes -- and the worrying failures -- of a decades-old universal system in the region's second-largest democracy, one that has brought real improvements in access for the poor, tempered by financial shortfalls, declining infrastructure, government inefficiency, and new, unanticipated forms of health-care inequality. Brazil's case illustrates that if you go public, you'd better be committed to maintaining your creation.

Brazil passed its reforms more than 20 years ago during an economic phase surprisingly similar to the United States' today: fiscal deficits, recession, inequality in access to health care, and loud demands for change. If recent town-hall bickerings across the United States look bad, look back at the unrest surrounding Brazil's implementation of universal health care in the early 1980s. Massive civic protests demanded an end to health-care inequality -- an ambition that dovetailed nicely with the broader democratization movement.

Like the United States today, Brazil also had a pre-existing health-care system that linked coverage to employment. A 1923 Brazilian law granted access to government-paid health care only to workers and those government officials contributing to the social security system. Informal or agricultural workers were left to pick at whatever services they could find from city officials and charities. The gaps left more than 90 percent of Brazilians without coverage by 1930.

The universal health-care system begun in 1988 was meant to change all this, enshrining access to care as a human right. The plan has two components: one public and one private, much like the plan that the Obama administration started out pushing for. Government-funded services are dished out through the decentralized Sistema Único de Saúde (Unified Health System, known as SUS), which relies on financing and management from federal, state, and municipal governments. SUS funds everything from annual checkups and free drugs to complex surgeries and health prevention education. On top of this government protection, businesses and individuals can purchase health care through private insurers, regulated by the Agência Nacional de Saúde Suplementar (National Supplementary Health Agency). Those who opt in to such a system receive a tax rebate for these expenses, though they do still contribute to SUS through their income taxes. And of course, anyone is still welcome to pay out of pocket at hospitals and clinics for service.

Financing for the public plan has always been a concern, in the same way it is in the United States. Brazil's federal, state, and local governments all raise revenue to help pay for health care. Taxes on such things as individual income, property, goods and services, banking transactions, and social security (at the federal level) help fill the pot. Yet even as Brazil has secured multiple sources of funding (something that will be very difficult to achieve under Obama), the cost of universal health care is quickly outpacing the revenue needed to sustain it. The World Health Organization estimates that health expenditures in Brazil have risen from 6.7 percent of GDP in 1995 to 7.5 percent in 2006. Although these figures are still far lower than the 15.3 percent of U.S. GDP that Americans spent on health care in 2006, Brazil's costs are growing faster. Lula does not seem committed to increasing the SUS budget because this could starve his other anti-poverty programs and make international creditors nervous about Brazil's economic stability. They are right to worry: Brazil will either have to spend more itself or end up borrowing from those same creditors to keep the program funded. As a core aspect of the 1988 democratic Constitution, SUS is unlikely to be shut down, no matter the cost.

Funding concerns aside, putting coverage policies in place has proven even harder. SUS does do an excellent job of providing primary care through its Programa de Saúde da Família (Family Health Program), staffed by about 28,300 teams of well-paid health-care workers who venture into poor and remote areas. But beyond the basics, there are alarming gaps. Brazil simply does not have the capacity to offer high-quality care to all. Hospitals lack basic infrastructure and personnel. Corruption peppers the local bureaucracy, and funds are often poorly allocated; politicians often fill budgetary committees with their friends, who neither know nor care much about public health. The mismanagement goes unpenalized because municipal health departments operate without federal oversight.

As a result of missing funding and poor management, the overall quality of Brazil's health-care system has gradually declined. So it's no surprise that those who can afford it opt for the private sector. The percentage of subscribers to private insurance saw an increase of about 38 percent between 1987 and 1995. By 2009, more than a fifth of the population had purchased private health insurance. The middle and upper classes are beginning to rely more on private insurers, while the poor rely more on the public sector.

Of course, the irony here is clear: Brazil's perceived solution to inequality in access to health care has bred even more inequality. The private sector has better infrastructure and technology, and treatment is immediate -- an appealing quality for those hoping to escape the long waiting lists for services in the public sector. What's more, those who have private care can still, at any time, sign up for public services, such as complex, costly surgeries or medicines that private insurance does not cover. Obviously, the poor cannot afford to stick their hands in both cookie jars.

Brazil's case spells out a clear message for the United States and the Obama administration: Halfway is no way at all. Without the money and institutional capacity to keep a public option working at the level of the private options, universal health care can simply create even more inequalities. And you'll be back to square one.

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