Healthcare and Afghanistan. We’re on the eve of history for both issues. In fact, they very well could ultimately define the Obama administration. And as different as they are, the approach to bettering both might be more similar than you think. Prevention.

In healthcare, prevention leads to longer, healthier living, at a fraction of the price. This is well documented. But less agreed upon – or even much discussed – is that the same can be applied to national security. That is, the more sustained goodwill we pour into a country, among its people, the more we prevent a costly disaster, in lives and resources, at their hands in the future.

Can you imagine if the US had continued its assistance to Afghanistan in the late '80s after the Soviets withdrew? That is, continued attention, financial and otherwise, not on guns, but on roads and schools and good governance? The Taliban would not have been able to flourish in that environment. Al-Qaeda would not have found safe haven there. 9/11 would not have happened.

And in cases where the US has actually pursued preventionist policies, the outcome has been positive. We see it in parts of eastern and southern Africa as well as Indoneisa.

As we’ve written in this blog before, channeling Bill Clinton: “We can be made more secure by eliminating inequality…. 10-20 countries in eastern and southern Africa… many of them Muslim… love the US.” This, at a time when the US has lost significant credibility internationally. In these countries, nobody has been thinking about Al Qaeda. Why? Because “we have cared whether their kids live or die.” Clinton is referring to America's generous African policies under Bush (that is, America's pledged financial support in the fight against AIDS and other diseases).

Across the ocean into Indonesia, the largest Muslim country in the world, ill-will towards America had reached alarming proportions in 2005. America’s approval rating was 38%. But after the tsunami, American assistance and goodwill blanketed the country, driving the approval rating up to 60%. In the same period, Osama bin Laden’s approval rating went from 58% to 28%.

With such drastic shifts in poll numbers, you can bet that bin Laden’s recruiting efforts amongst the world’s largest Muslim population suffered a major blow. We can only imagine how bin Laden might have gone from salivating over Indonesia as fertile ground for his network to perhaps averting it altogether. Can you imagine if the same thing happened in Afghanistan or Pakistan or Somalia or Sudan?

If prevention has proven effective and less costly (in the long term) than the alternatives, then why don’t we do it? We’ll offer some perspective on that in part II of this entry (in the coming days). But for now, let’s turn our attention to what Obama says tonight about Afghanistan. Might prevention play a role in his plan?

With Obama’s decision on Afghanistan imminent and Bill Clinton’s World Business Forum speech still resonant, we thought we’d do something of a thought experiment on leadership and decision-making.

What counsel might Clinton give President Obama on Afghanistan? Specifically, how would Clinton break down the current conundrum, and what advice on leadership and decision-making would he offer?

“Should we escalate in Afghanistan? I have three answers: Yes. No. Maybe.

Yes
September 11 has taught us that an unstable Afghanistan is a direct threat to the American people. That’s what makes this so different from Vietnam. Leaving the country will afford Al-Qaeda the same terrorist haven they enjoyed on September 10... and this time without as much resistance from a Northern Alliance.

No
Victory depends on commitment, and you don’t have it from the American people. Not even from your own Vice President. Americans want jobs, not increasing bloodshed abroad. Escalation without commitment will lead to another Vietnam.

Maybe
The Afghan people will support that group which cares for their children. Currently, they’re supporting the Taliban, but mostly out of fear. If we helped the Afghans build a sustainable country that was safer and more prosperous for their children, the Taliban wouldn’t have a chance.

The Afghan government is corrupt. We can build schools and train laborers, but buildings and skills will be gone or devalued once we leave, unless the Afghan government is there to support them. It’s unclear whether they have the will, or even the capability, to do that.

Pakistan is unstable; it’s also a crucial partner for success in Afghanistan. If they continue to assist the Afghan Taliban as a way to counterbalance India’s influence, or if a coup replaces the current regime with a much more hostile one, then we’ll have no chance of containing the Taliban along the porous Afghanistan-Pakistan border. Pakistan could be our biggest wild card. Their support is and will be paramount.

Leadership and Decision-making
The considerations are many, related, and complex. Regardless of what you decide, make sure you:
- Have a vision of where you want to go
- Lay out a strategy on how to get there
- Develop specific actions to implement the strategy
And underscore these things with an understanding of not just policy but also of people.

Some of the most difficult decisions I ever made as president were not necessarily the least popular – the unpopular decisions were sometimes easy because I knew what the right answer was – no, the difficult decisions were the ones for which I couldn’t know the right answer… those 10% of presidential decisions that can’t come from policy reports or staff recommendations, but rather must come from intuition. You have to listen and feel your way to the answer. If that happens, the best you can do is level with the people and say that if you’re not right you’ll change.

A great leader is a great decision-maker. You have one hell of a decision to make.”