Map of life expectancy at birth from Global Education Project.

Thursday, July 01, 2010

More on our dysfunctional political system

The New York Times manages to trigger symptoms of Intermittent Explosive Disorder about, oh, half the time, but mad props to Kevin Sack for doing this story and to the normally witless editors for putting it in the place of honor in the upper right hand corner of Page A-1. It really does say it all about the idiocy of our Congress.

For background, among the provisions of the Ryan White CARE Act is the HIV Drug Assistance Program, known as ADAP from the days when we didn't distinguish properly between HIV and AIDS. People who don't have adequate insurance can get their antiretroviral drugs paid for. Usually it's a temporary bridge, for people who are temporarily unemployed or haven't yet qualified for disability benefits and hence Medicaid. It's mostly financed by federal funds, with state contributions and a bit thrown in by the drug companies. (That's mighty big of them -- they profit in the end by keeping the people alive long enough to qualify for insurance.)

Well, you guessed it. With the Great Recession throwing people out of work and hence off of insurance; and state budgets swirling down the drain, states are starting to run out of ADAP funds. "Eleven states have closed enrollment in the federal program, most recently Florida, which has the nation’s third-largest population of people with H.I.V. Three other states have narrowed eligibility, and two of them — Arkansas and Utah — have dropped scores of people from the program," Sack tells us. There are already thousands of people without their meds.

Now, you may think this is stupid just because those people might get sick and die. But if you're Rand Paul or any libertarian, or a Republican in Congress, you couldn't care less about that. Tough shit, you say, not my problem, and anyway it would be far worse to add a few million dollars to the deficit than to give those people life saving pills.

But that's why you aren't so smart after all, for a few reasons.

1) People who are on ARVs and have suppressed viral loads have very little chance of passing the virus on to others. This will increase the incidence of new HIV infections and cost money. (Yes, people living with HIV should be responsible and not engage in unsafe practices, and most are, but there will always be exceptions.)

2) People who have interruptions in ARV treatment or take ARVs inconsistently, due to cost or any other reason, are likely to develop drug resistant virus. That means that once they do regain insurance, they will require more expensive drug regimens, which will cost money.

3) People who develop life threatening opportunistic infections or advanced AIDS are entitled to life saving urgent care in hospitals, which will obviously cost money.

4) People who have lost insurance due to unemployment, and then get sick from HIV disease, will not be able to return to work, and instead will have to apply for disability and Medicaid, which will obviously cost money.

Duhh. If instead we kick in the $10,000 year we need to keep these people on the meds, none of that will happen! It's called an investment. That it will also keep people healthy and save lives, well that's not important, but it's at least a minor side benefit that doesn't cost anything, but would actually save money. Therefore, obviously, it's not going to happen.

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