Tevi Troy explores for National Affairs readers the way three major 20th-century presidents approached public-health crises. Of particular interest is his treatment of Ronald Reagan’s approach toward the AIDS epidemic.

The case against Reagan on AIDS is well known. But does it correspond to the reality? According to Gary Bauer, the Reagan domestic-policy aide often painted as the villain in this saga, U.S. spending on HIV/AIDS research increased under Reagan’s watch, and Reagan’s relative silence on the issue stemmed from his philosophical belief in cabinet government, in which the Surgeon General should lead the charge on public-health issues. On the first point, funding definitely increased, as the U.S. government spent over $5.7 billion on HIV/AIDS under Reagan, a level that would later be designated as “disproportionate” in relation to other diseases. The columnist Deroy Murdock looked into the dramatic increases in AIDS funding under Reagan and concluded that “Reagan’s signature inaugurated federal action on AIDS research and treatment” (emphasis in the original).

On the second point, Surgeon General Koop was indeed outspoken on AIDS. In addition to smoking (as discussed above), Koop also made a big splash with his statements on AIDS. However, according to journalist Carl Cannon — son of top-notch Reagan biographer Lou Cannon — “Contrary to the prevailing wisdom, Reagan dragged Koop into AIDS policy, not the other way around.”

Furthermore, Reagan may have been slow in getting a complete handle on AIDS, but he was not alone, and he was not shy about the issue once he caught on. According to Richard Reeves, contrary to suggestions Reagan was unaware of the issue, “he obviously did know about the AIDS debate going on in the White House” in 1986. In early 1986, he visited the Department of Health and Human Services — a relatively rare step for a president — and told staffers there that “one of our highest public health priorities is going to be continuing to find a cure for AIDS.” The next spring, in April 1987, he declared AIDS to be “public health enemy number one.” …

… The point is not that Reagan was some kind of far-sighted visionary in dealing with AIDS. Not even his strongest partisans would make that case. However, what we have seen in the evolution of government responses to public-health crises is the degree to which, as in so many other areas, expectations placed upon government have increased.