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the late 1960s, when we were students at Oxford. From 1979 until he came to work in the White House, he founded and ran two successful corporate strategy firms with clients all across the world and wrote three books about the challenges of the emerging global economy. His long years of experience in the business world, his work on health care and electronic commerce in the White House, and his amazing ability to analyze complex problems and come up with creative solutions made him the perfect person for the job. I was especially glad Ira was able to take on this challenge because I always thought he took an unfair share of the blame for the defeat of my health-care plan in 1994. As I explained in my memoir, our effort to reduce costs and cover everyone was killed by politics, not by the plan’s particulars. Since 2000, all the cost and coverage problems have worsened, and there is a growing consensus among business, labor, consumers, and health-care providers that we finally have to change our system to rein in costs, cover everyone, and promote wellness, in addition to treating sickness. I am optimistic that we will finally address the challenge in the next couple of years. Meanwhile, Ira Magaziner is busy saving the lives of people with AIDS.

Initially, the plan we developed called for assembling volunteers to work with governments that asked for our help to increase care and treatment, beginning in the Caribbean. As we were getting organized, I asked wealthier nations to commit the funds necessary to upgrade and expand developing nations’ health services and to fund the purchase of generic drugs. Ireland and Canada were our first donors, followed by Norway, Sweden, and France, with other nations contributing lesser amounts. The foundation’s expenses were covered by private citizens’ donations from the United States, Canada, the United Kingdom, Ireland, and other nations.

We decided to buy generic antiretroviral medicines because they were so much less expensive, about $300 per person per year at the time. The government of the Bahamas was already providing generics to a few hundred people. Unbelievably, they were paying $3,500 per person per year for the $300 medicine because it was passing through two middlemen who were taking huge markups, showing just how disorganized the market was. We fixed that right away, enabling the Bahamas to buy almost ten times as many ARV pills with the same amount of money.

Then Ira set out to organize and enlarge the market. Enlisting the help of retired manufacturing executives, he worked with the major generic producers in India and South Africa to improve productivity and the efficiency of the supply chain and to negotiate a price reduction from $300 to $139. The manufacturers and suppliers of essential ingredients—Cipla, Ranbaxy, Aspen PharmaCare, Hetero, and Matrix—agreed to shift from a low-volume, high-margin, uncertain-payment business to a high-volume, low-margin, certain-payment one. Soon Ira and his team had also negotiated an 80 percent reduction in the cost of diagnostic testing and equipment with the major U.S. and European suppliers. Later negotiations led to reductions in the cost of the rapid HIV test from about $1 to between 49 and 65 cents; in some second-line drugs that have to be taken when the initial medications are no longer effective; and in pediatric AIDS medicine, from $600 to $196. In 2006, France imposed a small airline tax to raise funds to improve global health. Several other nations pledged contributions to the new program, known as UNITAID. The French asked our foundation to lead the UNITAID pediatric AIDS effort and committed $35 million to pay for the medicine. With the prospect of a huge expansion in the market, another round of negotiations cut the price of certain children’s medicine to $60 per child per year, just 10 percent of what it had been two years earlier.

Today our foundation’s AIDS initiative has more than six hundred people supporting its work in twenty-five nations. The rapid growth has required a great deal of help from donors. Canadian