TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/101689/10168900.081

Text File | 1990-09-19 | 6.1 KB | 106 lines

ETHICS, Page 88

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