There are several key preventable medical conditions which, independently and combined, make universal healthcare very difficult to finance. HIV/AIDS is perhaps the most preventable, and ending the epidemic could produce the largest single source of savings in both finance, lives, and medical resources, as well as produce the largest positive impact in the developing world.
And it's easy.
From many studies we know that current testing under-counts the number of new infections by about 20% per year. We also know that the financial cost per infection averages between $200,000 and $600,000 per case from diagnosis to death (a recent Harvard AIDS institute study). In round terms, that means that Massachusetts (as a fairly low infection-rate state) generated nearly $500,000,000 in long term liabilities last year with 820 documented (250 or so estimated un-documented) cases. That's a lot of money. It is a lot more than the current deficit at MassHealth. Even with large amounts of passthrough funding for SSI and other federal reimbursements, that kind of saving would - with HIV only - redeem the deficit EVERY YEAR.
We also know that the ONLY way to RETAIN those savings is with universal health care. Other savings inure to a scattered pool of public and private health insurers, and are lost to the general public.
And we also know that cheap, easy, fast tests are available to reduce that under-count of 20% and help both HIV+ and HIV- people control the rate at which new infections occur. There are four different paper tests that return reasonable findings of HIV+ status (a 1% overcount of positives, and an accurate count of negatives). Those paper tests can/could be used to help people find out if they really need a test, and then if they ought to begin treatment to control what could/probably is or will become a long term medical condition leading to AIDS, given current - and changing - medicine.
And, most startling, we also know - AND HAVE KNOWN FOR NEARLY 20 YEARS - how to reduce the probability of infection after a high risk exposure (through needles, sex, or blood). After a recent clinical trial at the Fenway Community Health Center, the state of Massachusetts supports 19 different health centers in providing what the field calls Post Exposure Prophylaxes (otherwise known as PEP). If someone has a high risk encounter, within 12 hours (at most 72 hours) they can go to a health center and begin a 1 day or 1 month cycle of medication to reduce the probability of infection to less than 20%. That's a very big discovery and a very big reduction.
Critical articles to building this case include the National Library of Medicine's summary of the Massachusetts experience to date (http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102240586.html) and the current, tentative, state guidelines (http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Provider&L2=Guidelines+and+Resources&L3=Guidelines+for+Clinical+Treatment&L4=Diseases+%26+Conditions&L5=HIV%26%2347;AIDS&sid=Eeohhs2&b=terminalcontent&f=dph_aids_c_pep&csid=Eeohhs2). From meetings with several of the agencies funded by the state to end this epidemic, I know that many of their own outreach staff are unfamiliar with this treatment. This merely confirms the problems cited in New York in 2001, that less than 70% of the voluntary and rape cases reported to emergency rooms were treated at all (http://www.liebertonline.com/doi/abs/10.1089/apc.2007.0157).
Why don't we do it? If not now, when?
It is feasible to end the HIV epidemic - with cheap, easy, fast testing and easy access to Post Exposure Prophylaxes (PEP) - and thereby finance universal health care with the very real financial and medical savings. Massachusetts can demonstrate that feasibility within 5 years, at most, and, at the same time, save many lives, develop skills critically needed by other states (and nations), and prove that prevention really pays (and thereby support prevention of diabetes, obesity, and loads of other conditions).
When do we start?
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