America Living With AIDS

AM E R I C A Living With AIDS

The sobering
reality is that health care is
indeed rationed in this
country. Only the rich can
afford it. Only the employed
can attain it. Only the
educated can exploit it. And
those who need it are left
without it. Subsequently, they
die faster. We have put a price
on living longer.
WILLIAM WAYBOURN
July 1990

bility for Medicare
requires a history of
employment. The Commission believes SSDI
beneficiaries who are disabled and have HIV disease or another serious
chronic health condition
should have the option of
purchasing Medicare during the current two-year
waiting period.
Also, while there are
obstacles to becoming eligible for Medicare, there
are also drawbacks to
Medicare coverage once
one receives it. The lack
of prescription drug ben
efits and limited long-term care benefits poses real problems for people
with HIV disease. Out-of-pocket
costs can be prohibitive for a beneficiary as a result of limitations such as
deductibles, coinsurance, the Part B
premium for physician services, and
uncovered services.
ADDITIONAL PROBLEMS
OF ACCESS TO CARE
A variety of factors may cause delays
or serve as barriers to early treatment
and care of individuals with HIV disease. Some of these factors are highlighted in the preceding chapter,
which discusses limitations in the
organization and delivery of HIV care.
The preceding chapter also looks at
ways in which fear of HIV transmission in the health care setting imperils

access to care by driving a wedge
between patients and their caregivers.
The following section discusses some
additional barriers to HIV care that
relate to financing issues.
CDC estimates that approximately 60
percent of individuals with HIV infection could benefit from early intervention. This means that even if there
were no further spread of the virus,
480,000 to 720,000 people should
receive such care right now. However,
individuals such as intravenous drug
users, the homeless, and those who
live in rural areas and who lack access
to care in general, may have limited or
no access to counseling and testing
and diagnostic resources and may not
receive care until it is an emergency.
Many others who do not have a primary care provider do not have access
to appropriate testing and counseling
services and have no access to the early
intervention services they may have
been told are now available for people
with HIV disease. Others are afraid to
be tested for a variety of reasons, not
the least of which is the very real fear
that they will be discriminated against
if they test positive, perhaps losing
their health insurance. CDC estimates
that only 12 percent of people who are
infected know of their HIV serostatus,
and fewer than that are receiving treatment. Equally alarming, when counseling is unavailable or inadequate,
HIV-infected individuals do not have
sufficient information upon which to
base decisions regarding treatment
and risk behavior changes.

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