TIME: Almanac 1993/TIME Almanac 1993.iso/time/101689/10168900.081

Text File | 1992-09-23 | 6KB | 120 lines

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Who Should Foot the AIDS Bill?


A deadly disease presents a ruinous IOU

By Andrea Sachs


    When Robert Simpson tested positive for the AIDS virus last
November, medical bills were the least of his worries. As a
court reporter, Simpson, 44, was earning $48,000 a year and was
covered by group health insurance. In addition, he had planned
ahead by buying three disability policies. Less than a year
later, however, he has fallen through the widening cracks in the
U.S. medical-care system. Too weak to work, he has lost the
insurance coverage from his job; moreover, he has yet to see a
penny from his disability policies, although he filed six months
ago. "I'm just tired of being a victim," the pale, bushy-haired
Simpson says slowly, pausing to gather strength in his San
Francisco apartment.

    Like Simpson, many of those caught up in the spiraling AIDS
epidemic are awash in medical expenses they cannot afford. And
the safety net beneath them has proved less than reassuring.
Since the AIDS crisis began in the early 1980s, the nation's
private health-care industry -- hospitals, insurance companies
and pharmaceutical firms -- has engaged in quiet combat with
government agencies over who should foot the bill for the
disease, which now afflicts an estimated 44,000 Americans. And
the tab is rising. This year the cost for AIDS medical care is
expected to be $3.75 billion; by 1992 that figure is likely to
more than double. Whose responsibility is it to pay for
AIDS-related care? And why does American society, on the whole,
seem to be shrinking from the task?

    No one is rushing in to assume the financial burden.
"Everyone is playing duck and cover while trying to shield
themselves from the costs," observes Ronald Brunk of AIDS
Benefits Counselors in San Francisco. This year federal and
state programs will pay 40% of the bill, with private insurers
taking care of another 40%. The remaining 20% falls in the "self
pay" -- often meaning "no pay" -- category. The most important
government program, Medicaid, is available only to impoverished
patients. As a result, those infected with the AIDS virus
frequently must "spend down" into poverty, demonstrating that
they hold assets of less than $2,000. This low level of federal
coverage portends future problems, since the number of people
with AIDS continues to rise. "Federal health planners have been
acting as if AIDS will go away," says Congressman Henry Waxman
of California. "It won't."

    The thicket of state insurance laws makes it possible in
some cases for private insurers to find ways to keep profits up
and payments for AIDS care down. In 1985 one firm, the Great
Republic Insurance Co., even issued an "AIDS profile" to its
agents, instructing them to treat differently applications from
"single males without dependents that are engaged in occupations
that do not require physical exertion." These applicants were
usually denied insurance. While such major insurers as Blue
Cross/Blue Shield and the Travelers deny discriminating on the
basis of AIDS, others still use information about living
arrangements, residences and Zip Codes to try to identify gay
or bisexual men at risk for the disease. Testing applicants for
the AIDS virus gives companies additional protection against
insuring infected individuals who will have high medical costs.
As a result, a number of jurisdictions, including Washington and
the states of Florida, Maine, Wisconsin and California, have
legislatively limited such testing.

    Despite the substantial costs (average lifetime care for a
person with AIDS: about $83,000), a fifth of those infected
with the AIDS virus have no insurance at all. Increasingly,
these people are flooding into overburdened public hospitals,
raising fears of bankruptcies. In August the National Public
Health and Hospital Institute reported that in 1987 only 5% of
the nation's hospitals, most of them in inner cities, were
treating 50% of the country's AIDS patients. Bellevue Hospital
Center, which has one of the biggest emergency rooms in New York
City, is overwhelmed to the point that care for other patients
is threatened. Says Bellevue's Dr. Lewis Goldfrank: "There is
going to be hospital gridlock by 1990, because there's not
enough long-term, short-term or emergency-care space for AIDS
patients. I think they're eventually going to fill every
hospital bed in the big cities."

    The stigma attached to the groups primarily afflicted by
AIDS -- gays, minorities and intravenous drug users -- has
unfairly limited the degree of economic assistance offered. "If
this disease struck only the presidents of major corporations,
the effort to evade responsibility would not have been tolerated
by society," says Earl Shelp, executive director of Houston's
Foundation for Interfaith Research and Ministry. Additionally,
society's sense of financial obligation -- not to mention its
compassion -- has been diminished by a blame-the-victim
syndrome. "I think that there is a tendency to discount a
situation if one feels that an infected person's condition could
have been avoided," says Dr. Kathleen Nolan of the Hastings
Center in Briarcliff, N.Y. Alluding to the disease's long
incubation period -- frequently ten years or more -- she adds
that "the vast majority of individuals who are seropositive or
who have AIDS had never heard of the virus before they engaged
in the behavior that resulted in their infection."

    The mounting bills for AIDS patients have renewed a call in
some quarters for a national medical-care system.
"Optimistically, AIDS will push this country into getting
universal health insurance," says New York City Health
Commissioner Stephen Joseph. "Or we may be reduced to
narrow-minded scrambling to see who gets what piece of the pie."
However, the current budget crisis, plus resistance to
socialized medicine, makes that prospect a far-off solution. In
the short run, a combination of public- and private-sector
responsibility, translated into cash, seems to offer the best
hope for coping with this ongoing human crisis.


-- Cheryl P. Weinstock/New York and Dennis Wyss/San Francisco