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A National Single payer Universal Healthcare System may just finally deliver healthcare for all people with HIV/AIDS living in the USA.

HIV/AIDS is a fatal chronic illness with no cure. It requires that patients receive expensive anti-retro-viral combination therapies for life. The treatment of HIV disease requires constant medical monitoring, including the use of sophisticated laboratory tests every three months of the patient’s blood and bodily functions. Currently, the medical cost for the treatment of HIV disease is measured in the tens of thousands of dollars per year.

According to the Center For Disease Control, over one million Americans are living with HIV/AIDS. It is estimated that as many as 250,000 Americans with HIV/AIDS have no idea that they are infected with the HIV/AIDS virus. Approximately 160,000 of the people with HIV/AIDS are uninsured, according to the Kaiser Statewide HIV/AIDS statistic database.

More than twenty years after the discovery of the virus, it is not only appalling that all people who are infected do not know their status; their ignorance is also a public health threat. People who do not know they are infected, are more likely to engage in unsafe behavior than people who know they are HIV Positive. It is believed that people’s lack of knowledge of their HIV infection facilitates many of the over 40,000 new HIV infections every year.

The greater access to healthcare and health education that a national single-payer system would provide, would increase opportunities for informed consent and counseling for HIV testing and the follow up counseling needed for early intervention and treatment.

People who know they are HIV positive are less likely to engage in unsafe behaviors. HIV/AIDS treatments reduce the amount of HIV virus in the blood and bodily fluids of people who are HIV infected. Thus, infected individuals receiving HIV treatments are less likely to transmit their virus to other people during unsafe behavior.  Therefore, HR 676, which includes systematic universal access to HIV testing and medications, could help to reduce new HIV infections.

People with HIV/AIDS must take HIV Anti-retro viral treatments for life. Currently the average cost of prescription drug treatment for someone with HIV/AIDS in The United States is approximately $15,000 per year. Other developed democracies pay between 33% and 50% less for the same name- brand drugs that we in the US purchase at retail. 

The average cost of treating someone with HIV in Brazil, where their government has made a commitment to providing free treatment with more affordable generic drugs, to everyone who is HIV infected, is $2,500. HIV/AIDS treatment access programs in the developing world, using generic medication, have reduced the average costs of treatment per patient to less than $350 per year.

A recent study by the Brazilian Department of Health estimates that their practice of providing free HIV treatment has prevented tens of thousands of deaths, prevented tens of thousands of new HIV infections, avoided hundreds of thousands of daily hospital stays and saved their government hundreds of millions of dollars.

The Institute of Medicine’s report on Public Financing of HIV/AIDS care says that in the United States, over 250,000 people with HIV lack stable access to consistent HIV/AIDS medications, and should be receiving HIV Treatments, but are not receiving these medications because there is no funding mechanism on which they can consistently rely.

HR 676, the only single-payer federal bill and most comprehensive solution to the US healthcare crisis, includes provisions for bulk purchase by the US Federal Government of all drugs at discount prices. The cost savings from this provision would likely save enough money to pay for the medications for all people living with HIV/AIDS who currently lack access to these drugs. The artificially high cost of life saving anti-retroviral drugs is assigning people to premature death. A single payer national healthcare system would dramatically reduce the cost of all prescription drugs to everybody.

Providing individuals who are not receiving anti-retroviral drugs with anti-retroviral drug treatments would lower the risk of them infecting other individuals. In addition, providing this population treatment would save significantly higher medical costs from treating the illnesses that they contract when they are denied treatment and are subsequently forced to develop full blown AIDS. AIDS is an illness that can be avoided if these individuals are provided with HIV treatments in a timely manner.

Currently, people with HIV who don’t have health insurance can obtain medical care and gain access to HIV treatments thru a variety of governmental programs; but many people with HIV who need HIV medications and access to healthcare for their HIV illness, lack access to both. The mechanisms for people with HIV to receive healthcare are primarily Medicare and Medicaid and in some cases the AIDS Drugs Assistance Program.

Eligibility for Medicaid is limited to people who are over 65 and those who are disabled and living below the poverty level for more than two years. To gain Medicaid eligibility, a person with HIV has to delay treatment for HIV until they have become so sick that their illness has progressed to full blown AIDS and they have become so sick that they qualify as permanently disabled. This is unconscionable. They also must divest themselves of all of their assets, if they have any, and spend down to the poverty level.  It is inhumane that the US Government forces people to become incapacitated paupers in order to avail themselves of our nation's medical safety net. This systemic pauperization is a further drain on the national economy due to this preventable cost of healthcare and the absence of valuable talent and energy in the workforce.

Individuals sick enough to be declared disabled under the Social Security guidelines can also access the Medicare system – providing them with access to free medical care at participating doctors, hospitals and participating health facilities, but they are not provided with any medications through this program, not even necessary HIV medications.

The AIDS Drug Assistance Program does provide free access, in most states, to some HIV medications for some people who are HIV infected. These programs, however, require contributions from State and Local Governments and have budget restrictions that in some states have created waiting lists on which a growing number of people with HIV die, before ever reaching the top of the list. Other state programs have income restrictions set so low that many of the state’s working poor can not qualify for the free drugs, even though they make so little money that they cannot afford to purchase either health insurance or the HIV medications they need. It is estimated that the federal government pays over $100,000,000 for HIV medications through the AIDS Drugs Assistance Program (ADAP) alone.

HR 676 would correct all of these problems, providing everyone in the country, including all people with HIV/AIDS, with free, quality healthcare and access to state of the art pharmaceuticals, diagnostic tests and treatments. The requirements of bulk purchasing of pharmaceuticals, by the government, at negotiated discount prices, would save enough money to provide all Americans with the prescription drugs they need.

HR 676 also includes provision for eliminating the cost-draining, private insurance company middlemen from the healthcare finance and delivery system. This action alone would save enough money to pay for all the healthcare needs of the 47 million uninsured Americans.

Private insurance companies’ administrative overhead wastes approximately 1/3 of every healthcare dollar. By their own admission, over 30 cents of every dollar paid for private health insurance premiums is spent on administrative costs. The Medicaid/Medicare system administrative cost, by comparison, is only about 3% of every healthcare dollar. The difference is accounted for by duplicative billing costs, marketing costs, return to shareholder costs, and the excessive executive compensation costs of private insurance companies.

Eric Sawyer is seasoned grassroots human rights activist. He is a member of the national steering Committee of Healthcare-NOW. He is a person living with AIDS. In addition, he is the co founder of ACT UP, HousingWorks, and Healthgap. Click here to contact Mr. Sawyer and Healthcare-NOW.

Click here to read any of the articles in this special BC series on Single-Payer Healthcare.