Using Dollar Triage on AIDS Victims

Ever since my friend Dr. Tom Waddell died of AIDS, I have tried not to think too much about the epidemic. It was just so hopeless and depressing. For a year before his death, I had covered AIDS almost as a battlefield story, returning safely at night from the wards of San Francisco General Hospital or the offices of AIDS Project LA to the company of people who, despite their decency, were nonetheless oblivious to the carnage occurring so near but so far away. The disease in those first years was viewed as largely tribal in its impact, and it was, and generally has been, possible for most of us to avoid the true horror of its consequences.

I continued to write about the need for more funding for research and education and against discrimination aimed at those who are HIV positive. But admittedly, I was so pessimistic about the potential for medical science to treat the disease that I became numbed to its impact for people in the here and now.

My last conversation with Tom, a physician who had conducted viral research, took place just before he died. I had called him from the Centers for Disease Control headquarters in Atlanta, attempting to cheer him up with some positive findings that, once again, turned out to be illusory. Tom, who represented the U.S. in the decathlon at the Olympics held in Mexico City and helped launch the gay Olympics, was a model of poise and courage.

He was also a clinician and told me this was going to be a long struggle, and that while any real breakthrough would come too late for him and for so many of his neighbors and friends in the Castro district of San Francisco, it was essential for researchers to keep trying. And for the public to support them.

Tom, who treated AIDS patients before he was stricken himself, would be thrilled that there has been a breakthrough and that the prospect for containing, if not eliminating, the ravages of this plague is now at hand. But he would be outraged to learn that people who could be saved by the new pharmaceutical “cocktails” will die because they cannot afford the $10,000 to $15,000 yearly cost of the medication.

These folks are in the middle class that politicians claim to care so much about. The destitute are presumably covered by Medicaid, although state restrictions make that less than certain. The well-off can afford the treatment. But those being deprived of this chance at life fall into the category of people who, despite having worked hard all their lives, do not have health insurance or have run up against the prescription drug cap written into the health plans for which they paid.

In 1987, President Reagan signed into law the AIDS Drug Assistance Program to help just such people, but the program is now $260 million short of what is needed this year. “Without that money, people who can be saved will die,” Gary Rose of the AIDS Action Council told me. The money would cover treatment for more than 70,000 AIDS patients, allowing them to return to work--and pay taxes. It’s both life affirming and cost effective.

Is it too much to ask that all of us, the Christian Coalition and the ACLU, liberals and conservatives, Dole and Clinton, unite in insisting that the federal government guarantee the right to life of people who would benefit from this medication? There is a clear precedent in the federal government’s guarantee of treatment for those whose kidneys have failed. To those who would like to add other illnesses to the list to save people who can be saved but who can’t afford the medication, I would say yes--that’s precisely why we need universal health care. But let’s not muddy the argument by bringing it up now, when a particularly promising treatment exists for the HIV population that only recently had no basis for hope.

The AIDS epidemic is special. At no time in modern history have a people suffered the way gay men have, struck down in the prime of their youth by a plague that decimated their ranks while it ignored most others. Of course, the list of the stricken has swelled to include heterosexuals. But the suffering was not general enough to put us on an emergency war footing when the disease first began to spread.

We as a society failed in many ways--by not providing incubators to study the virus, by not encouraging the use of condoms to prevent its spread, to name two--at a time when it could have made a great difference. Now we must seize the opportunity to declare a truce, if not victory, in this horrible war that has claimed so many wonderful people, including my friend Tom.