Like I said, not paying for stuff is not the same thing as saving money

It's unavailable to you common riffraff (and if you think I've been a tiresomeless crusader for open access, I still haven't gone as far as this guy), but there's an important story by Richard Trubo in the new JAMA. Thirteen states now have waiting lists for their AIDS Drug Assistance Programs, because they have chosen not to pay the cost of enrolling everyone who needs the program. The federal government provides more than $880 million through the Ryan White Program, but the states are expected to contribute as well.

The list of states with waiting lists probably won't surprise you: Arkansas, Louisiana, Florida, Alabama, Georgia, South Carolina, North Carolina, Virginia, Utah, Idaho, Montana, Wyoming, and Ohio. If Ohio seems a bit less obvious, let's not forget who is currently the governor of that purplish state. Right now, from 100 to 200 people are being added to these waiting lists every week.

As Trubo suggests, without quite spelling it out, this is not exactly a smart way to save money. In the first place, we now know that when people are treated with antiretroviral drugs, they are much less infectious. As a matter of fact, if everybody with HIV were treated successfully, the epidemic would come to an end. That's not likely ever to happen, but all of these untreated people represent a risk of creating new HIV infections that could be avoided.

Oh yeah -- if they don't get off the waiting list fairly soon, they will start to develop AIDS, which means they'll end up in the hospital, with opportunistic infections, which will be more expensive to treat, and they will have to get a supply of ARVs -- until of course they get better, at which point their situation is no longer an emergency and they don't have to get the drugs any more, until they get sick again, and around and around we go. That's really, really smart Tea Partiers.

Unless, of course, the people die. That will indeed save money. Maybe that's the real idea.