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Gordon Nary
The International Association of Physicians in AIDS Care

July 1997

"The body politic, like the human body, begins to die from its birth, and bears in itself the causes of its destruction." Jean Jacques Rousseau's words resonate over 230 years after he wrote Du Contract social, and explain the current state of politics in Washington, DC. In June, the Republican congressional leadership bore the cause of its eventual destruction by stalling passage of the desperately needed disaster relief bill. The federal government's handling of this critical bill again demonstrated its greatest weakness -- placing politics before human life and suffering. Like the affectless samurai warriors they continue to emulate, our government officials performed a very public act of hara-kiri the likes of which we have unfortunately witnessed over and over again.

Equally emblematic of this hara-kiri mentality, but largely ignored in the disaster-relief debacle, was the behind-the-scenes wrangling involving a possible temporary solution to the nationwide AIDS Drug Assistance Program (ADAP) budget crisis. An amendment championed by Representative Nancy Pelosi (D-Calif.) proposed to add $68 million in additional funding for ADAPs this year. The added funds, while falling short of what is truly needed ($131.7 million by some estimates), could have relieved the stresses on a program that provides the only chance for thousands of our citizens to stay alive. These funds could have helped alleviate the crisis in Mississippi, where hundreds of ADAP enrollees were dropped from the program because of a budget shortfall. Did the amendment pass? Did our elected officials in Washington recognize the importance of getting treatments into the hands of their constituents living with HIV and AIDS? Short answer: No.

It should be obvious to most of us outside the Washington Beltway that, when a state must drop people with AIDS from its ADAP because of budget shortfall and other sources of revenue cannot be found (and at least 11 other states are facing similar circumstances), we cannot just ignore the people affected and let them die. Something must be done. Yet the body politic missed its opportunity to do the right thing. Pelosi's amendment, which was to be attached to the disaster relief bill, was never vetted with the White House. As a consequence of this failure, the Clinton administration eventually rejected the amendment, claiming "there is no evidence there is an ADAP crisis." Members of Congress from both parties said they would support supplemental funding for ADAP, but only on the condition that the Clinton administration requested the additional funding. Neither side would budge. The stalemate resulted in an expanding ADAP crisis. Thousands of people with HIV/AIDS were immediately at risk of losing access to life-saving drugs. We witnessed another example of the federal government's ability to shoot itself in the foot. However, this time the bullet ricocheted and will soon harm those who are ill, poor, and living in a resource-poor state.

Again Rousseau: "At length I recollected the thoughtless saying of a great princess, who, on being informed that the country people had no bread, replied, 'Let them eat cake.'" Like Rousseau, the people of our nation have also reflected on the thoughtless actions of our privileged leaders who, upon being informed that some of our poor with HIV disease would die without the drugs they so desperately need, replied, "Let them have nothing."

©1997, Medical Publications Corporation

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