America Living With AIDS

C H A PTER FOUR
HEALTH CARE
FINANCING
aps in the United States health care
financing system have been made increasingly evident by the HIV epidemic. Millions of Americans are without health insurance and thus face significant barriers to
needed care. The first decade of AIDS coincided with a period of great ferment in
health care financing, during which numerous proposals emerged for improving
access and quality of care and limiting rising costs. Although health care access is
not a problem unique to people with HIV disease, the HIV epidemic does pose
some unique challenges for the health care system. It adds to a problem that has
grown beyond the scale that can be solved by piecemeal tinkering. Fundamental
reforms are needed, and it will clearly require political courage to propose and
implement them.
Part of the Commission's mandate from Congress is to "evaluate the adequacy of,
and make recommendations regarding, the financing of health care... relating to
AIDS." This chapter does so in considerable detail. By necessity, however, the discussion goes beyond the mandate, for a financing reform proposal addressed solely to
HIV disease would provide selectively and perhaps only temporarily for that population while ignoring the larger, more systemic problem.
The Commission urges the President and Congress to address the health care
problems of all people living in the United States by supporting universal health care
coverage. This coverage should be comprehensive and include prescription drugs.
No person living in the United States should be denied health care because of an
inability to pay, nor should people be forced into poverty or left without dignity
because they are unfortunate enough to have a major health problem. Our nation
must do what virtually every other major industrialized nation has done-adopt a
universal health plan that ensures access to health care for all its citizens.
Unless action is taken, the ranks of the uninsured and underinsured will continue
to grow, opportunities for HIV education, prevention, counseling, and early inter
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