Luncheon for Top Aides to Republican Senators

Talking Points:

          1.  Strategies for control of spread of AIDS for those

           already infected or at risk.

          2.  Resources for care and treatment.

          3.  Potential economic impact.

          4.  The U.S. role in the global response to AIDS

You need only talk for 20 minutes and answer a few questions.


THOSE TWO SYMPOSIA WOULD BE SO

GOOD, I'VE FELT A LITTL                WITH SOMETHING

DIFFERENT AND IMPORTANT TO SAY TO YOU AT THIS PLEN

  w, I'M NOT GOING TO DWELL ON A GREAT MANY

PARTICULARS CONCERNING THE DISEASE OF AIDS, THE DAILY PRESS --

AND OUR PROFESS I ONAL JOURNALS -- DO i VERY GOOD JOB OF THAT,

BUT, AT THE VERY LEAST, I WILL UNDERSCORE THREE OF THE MOST

IMPORTANT FACTS ABOUT THE DISEASE OF AIDS , , a BASIC FACTS THAT

INFLUENCE JUST ABOUT EVERYTHING WE SAY OR DO ABOUT THE VIRUS AND

ABOUT THE PEOPLE INFECTED WITH IT,


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FACT NUMBER ONE, THE DISEASE IS SPRt3WK

  THE WORLD HEALTH ORGANIZATION CALLS AIDS A "PANDEMIC" -- AN

EPIDEMIC THAT IS EXPANDING AND ROLLING ACROSS ALL THE WORLD'S

BOUNDARIES, GEOGRAPHIC OR DEMOGRAPHIC,

  HERE IN THE UNITED STATES, AS I'M SURE YOU KNOW, MORE THAN ,.

53,000 PERSONS HAVE BEEN REPORTED AS HAVING AIDS, SINCE THE COUNT

BEGAN IN JUNE OF 1981,


5

  TO DATE, NO STATE HAS HAD FEWER THAN 5 CASES OF AIDS a., AND

20 AMERICAN CITIES HAVE EACH REPORTED MORE THAN 400 CASES OF AIDS

OVER THE PAST 7 YEARS,

IN OTHER WORDS, IT IS FOOLISH TO THINK YOU CAN JUST SIT

TIGHT AND WAIT FOR AIDS TO PASS YOU BY OR GO AWAY, THAT'S NOT
GOING TO HAPPEN, 'FOR MANY OR EVEN MOST OF US IN THIS ROOM

TONIGHT, AIDS WILL NOT DISAPPEAR IN OUR LIFETIMES,

THE SECOND FACT IS THAT AIDS IS VIRTUALLY FATAL,


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  OF THE 5%000 PERSONS WHO'VE REPORTEDLY HAD AIDS, SOME

30,000 -- MORE THAN HALF -- HAVE ALREADY DIED, AND OUR

EXPERIENCE TELLS US THAT THE REST PROBABLY WILL,

  IN FACT, 93 PERCENT OF THOSE WITH AIDS BACK IN 1981 HAVE

ALREADY DIED, AND IF YOU KNOW YOUR EPIDEMIOLOGY, YOU KNOW THAT

A 93 PERCENT FATALITY RATE IS AS GOOD AS 100 PERCENT.


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  BUT JUST AS AN ASIDE, LET ME SAY THAT I HAVE ABSOLUTELY NO

DOUBT THAT OUR COLLEAGUES IN RESEARCH WILL COME UP WITH A VACCINE

TO PREVENT THE SPREAD OF AIDS ONCE AND FOR ALL, REALISTICALLY

THAT DAY IS STILL QUITE FAR OFF ,,m MAYBE A DOZEN YEARS OR MORE

DO\JN THE ROAD,

IN THE MEANTIME, THEREFORE, WE MUST LIVE WITH A DISEASE THAT

HAS ONE OF'THE HIGHEST MORTALITY RATES OF AFJY DISEASE WE'VE KNOWN

-- PAST OR PRESENT,


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FACT ONE: IT'S SPREADING, FACT TWO: IT'S FATAL,

BUT FACT THREE IS MORE DIFFICULT TO STATE QUITE AS BALDLY AS

I'VE STATED THOSE OTHER TWO, AT ANY RATE, FACT THREE IS THIS:

THE AIDS VIRUS IS TRANSMITTED THROUGH SPECIFIC ACTS OF
BEHAVIOR THAT THE GREAT MAJORITY OF PEOPLE DON'T ENGAGE IN '

AND DON'T APPROVE OF,


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  ANAL INTERCOURSE IS ONE OF THESE BEHAVIORS, NEEDLE-SHARING

AMONG DRUG ADDICTS IS ANOTHER, THESE TWO BEHAVIORS ACCOUNT FOR

ABOUT 90 PERCENT OF THE TOTAL AIDS CASELOAD,

AS I NOTED EARLIER, THESE THREE FACTS INFLUENCE VIRTUALLY

EVERYTHING WE SAY OR DO ABOUT THE AIDS EPIDEMIC. SOMETIMES

THAT'S GOOD, AND SOMETIMES IT'S NOT SO GOOD,

FOR EXAMPLE, THESE THREE PECULIARITIES OF THE AIDS EPIDEMIC

HAVE INFLUENCED THE MANNER IN WHICH SOME HEALTH PROFESSIONALS

ARE RESPONDING TO THE AIDS CRISIS am, OR, MORE PARTICULARLY, ARE

m RESPONDING TO THE AIDS CRISIS.


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  I THINK, FIRST, IT NEEDS TO BE SAID THAT THAT THE
OVERWHELMING MAJORITY OF OUR COLLEAGUES HAVE PROVIDED' -- AND WILL

CONTINUE TO PROVIDE -- QUALITY, COMPASSIONATE CARE TO PERSONS
DYING OF AIDS,

  AND I WANT TO ADD A SPECIAL WORD OF PRAISE FOR THE
PHYSICIANS, NURSES, TEACHERS, SOCIAL WORKERS, AND OTHERS IN AREAS

WITH THE HIGHEST CONCENTRATIONS OF AIDS CASES 1.1 SPECIFICALLY,

THE CITIES OF NEW YORK, SAN FRANCISCO, LOS ANGELES, NE\I/ARK, AND

MIAMI,


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  OVER 40 PERCENT OF THE NATION'S AIDS CASELOAD HAS APPEARED

IN JUST THOSE FIRST THREE CITIES ALONE: THAT IS, NEW YORK, SAN

FRANCISCO, AND LOS ANGELES, AND THE RESPONSE BY THE GREAT
MAJORITY OF HEALTH PROFESSIONALS IN THOSE CITIES HAS BEEN

OUTSTANDING,

  HOWEVER, EVEN THERE -- AND IN MANY OTHER CITIES ACROSS THE

COUNTRY -- WE ARE SEEING A MOUNTING NUMBER OF INSTANCES IN WHICH
HEALTH PROFESSIONALS REFUSE NOT ONLY TO TREAT PERSONS WITH AIDS,
BUT ALSO TURN A\IAY PATIENTS ALLEGED TO BE FROM POPULATION GROUPS

IDENTIFIED WITH THOSE TWO HIGH-RISK BEHAVIORS: THAT IS,

HOMOSEXUALS AND BISEXUAL MALES AND INTRAVENOUS DRUG ABUSERS,


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FOR GOVERNMENT, FOR THE PROFESSIONS INVOLVED, AND FOR

AMERICANS GENERALLY, THIS KIND OF BEHAVIOR BY AN IRRATIONAL

MINORITY MUST BE A CAUSE FOR DEEP CONCERN,

OF COURSE, THE REASON MOST OFTEN GIVEN IS THAT AIDS IS

CONTAGIOUS AND FATAL AND "1 DON'T WANT TO GET IT/'

  BUT THE PLAIN FACT IS THAT THE RISK OF CONTRACTING AIDS FROM

AN INFECTED PATIENT IS EXTREMELY SMALL, OF THE NEARLY 7 MILLION

AMERICANS IN THE HEALTH PROFESSIONS, WE KNOW OF FEWER THAN A

DOZEN WHO HAVE BECOME INFECTED \IITH THE VIRUS WHILE DOING THEIR

JOBS,


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  AND IN 8 OR 9 OF THOSE 8 CASES, NOTHING WOULD HAVE HAPPENED,

IF THE PERSON HAD FOLLOWED THE COMMON-SENSE WORKPLACE GUIDELINES

PUBLISHED BY THE CENTERS FOR DISEASE CONTROL TWO YEARS AGO,

  THE DECISION BY SOME HEALTH PROFESSIONALS TO DENY CARE TO

HOMOSEXUALS, I ,Va DRUG ABUSERS, OR OTHERS SUSPECTED OF CARRYING

THE AIDS VIRUS IS, THEREFORE, IRRATIONAL AND UNWORTHY OF ANYONE

IN THE HEALTH OR SOCIAL SERVICE PROFESSIONS,  IT IS A DECISION

BASED MORE ON FEAR OR DISLIKE OF THE CARRIER OF THE VIRUS, AND

LESS ON THE VIRUS ITSELF,


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   WE DEFINE AND CATEGORIZE DISEASE CONDITIONS IN ORDER TO

TREAT THEM,  BUT WE NEVER DEFINE WHO IS -- AND IS tJOJ --

ACCEPTABLE AS A PATIENT OR CLIENT, IN ORDER TO DENY TREATMENT TO

SUCH A PERSON,

WE NEVER DO THAT,
AND I WOULD HOPE WE WOULDN'T START NOW,

  AS I READ AND LISTEN TO THE STATEMENTS OF THOSE 'INDIVIDUALS
AND ORGANIZATIONS WHO WISH TO WITHHOLD CARE, I'M STRUCK'BY THEIR

CURIOUS APPEALS TO SCIENCE AND TO THE LAW,


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  THEY SAY, IN EFFECT, "LOOK, WE STILL DON'T KNOW EVERYTHING

ABOUT THIS DISEASE, THEREFORE, WHY SHOULD I TAKE A RISK?" OR

THEY SAY, "LOOK, THE COURTS HAVEN'T YET TAKEN A LOOK AT THIS
QUESTION, THEREFORE, WHY SHOULD I TAKE THE RISK?"

   MY ANSWER -- AND I DEEPLY HOPE IT IS YOUR ANSWER AS WELL --

COMES DOWN TO THIS:


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"NO, WE DON'T KNOW EVERYTHING ABOUT THE DISEASE OF AIDS , a,
AND NO, THE COURTS HAVE NOT LOOKED AT ALL THE ISSUES, BUT

THAT'S NOT WHAT HEALTH CARE IS REALLY ALL ABOUT ANYWAY,

IT'S ABOUT CARING FOR PEOPLE WHO NEED OUR EXPERTISE TO LIVE

I I I AND IT'S ABOUT OUR PROVIDING THAT CARE AS BEST WE CAN,

WHENEVER IT'S NEEDED?

THE THINGS WE ARE TRAINED TO DO ARE THINGS THAT GIVE PEOPLE

HOURS, DAYS, OR EVEN YEARS MORE OF LIFE,


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  OUR "CALLING," IF YOU WILL, IS A CALLING BASED UPON THE MOST

VALUED ETHIC IN HUMAN HISTORY aat AN ETHIC THAT HAPPENS TO BE

INTEGRAL TO OUR PROFESSIONAL OATH, WHICH SAYS,, m

"DO WHAT YOU CAN TO HELP , , a BUT IN ANY CASE DO NO HARM,"

   THAT OATH HAS BEEN SUBSCRIBED TO FOR GENERATIONS IdITHOUT

NUMBER, YET, I TRULY CANNOT RECALL ANY TIME IN THE PAST QUITE

LIKE THIS ONE, WHEN THE MEDICAL PROFESSION HAS AWGUISHED SO MUCH

OVER THE BURDENS OF ITS OWN HIPPOCRATIC OATH,   AMD WE'VE HAD

MANY OPPORTUNITIES IN PRIOR TIMES,


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  HERE IN THE UNITED STATES, IN THE lgTH CENTURY, YELLOW FEVER

SWEPT THROUGH OUR MAJOR CITIES, ESPECIALLY IN THE SOUTH, LEAVING

THOUSANDS OF DEAD IN ITS WAKE a I, 4,000 DEAD IN NEW ORLEANS a,,
5,000 IN MEMPHIS, TENNESSEE em m AND SO ON,

  PHYSICIANS AND NURSES SHOWED EXCEPTIONAL HEROISM DURING

THOSE YEARS OF PLAGUE a  IT IS SAID, FOR EXAMPLE, THAT A THIRD Oi
THE PHYSICIAMS OF SAVANNAH, GEORGIA, WERE AMONG THE HUNDREDS OF

CITIZENS WHO DIED WHEN YELLOW FEVER STRUCK THAT CITY IN 1854,


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NO SANE PERSON -- IN OR OUT OF THE HEALTH PROFESSIONS --

WANTS TO DIE FROM A VIRULENT DISEASE, BUT THE HEROISM OF THOSE

SOUTHERN HEALTH WORKERS SHOULD BE AN INSPIRATION TO US ALL, THEY

DID NOT WAIT FOR SCIENCE OR THE LAW TO TELL THEM THE "RIGHT"

TIME TO TAKE THE "RIGHT" COURSE OF ACTION,

THEY TOOK THEIR CUES FROM THEIR HEARTS AND FROM THEIR

CONSCIENCES, AND WE REVERE THEIR MEMORIES BECAUSE OF THAT.


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  THESE KIFdDS OF EXPERIENCES ARE IMPORTANT TO RECALL BECAUSE

WE MUST ALWAYS REINFORCE, THROUGH HISTORY AS WELL AS THROUGH

PERSONAL EXAMPLE, THE NOTION THAT THE HEALTH PROFESSIONS HAVE THE

ETHICAL DUTY TO TREAT,

AND I DO 1dOT WANT TO SEE THE DISEASE OF AIDS -- WHICH CAM

DEVASTATE AN INFECTED HUMAN BEING -- \fREAK SIMILAR HAVOC UPON Tt!E

CARING AldD HELPING PROFESSIONS IN OUR SOCIETY,


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  YES, AIDS IS A DANGEROUS DISEASE, YES, IT CAN BE FATAL,

AND, YES, YOU MAY NOT APPROVE OF THE KINDS OF BEHAVIOR BY WHICH

THE DISEASE IS TRANSMITTED,

BUT IF YOU CHOSE A LIFE OF MEDICINE OR DENTISTRY OR NURSING,

YOU CHOSE TO SERVE YOUR FELLOW HUMAN BEINGS IN THEIR TIME OF NEED

-- AND YOU IfERE NOT GIVEN, IN RETURN, ANY PRIVILEGE TO JUDGE

THEM@

TREATMENT MAY BE DIFFICULT a,, AND IT MAY -- REMOTELY -- BE

DANGEROUS,

BUT TREATMENT MAY NOT BE DENIED,


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  THE DISEASE OF AIDS, THEN, IS TESTING THE DEGREE TO WHICH

HEALTH WORKERS -- PHYSICIANS, NURSES, TECHNICIANS, AND OTHERS --

UNDERSTAND AND ARE TRULY DEDICATED TO THE ETHICAL FOUNDATION OF

HEALTH CARE ITSELF,

   AND I WOULD REMIND YOU THAT SUCH A TEST IS COMING QUITE
EARLY IN MANY PROFESSIONAL CAREERS,  WE ARE ALREADY NOTICING,

FOR EXAMPLE, THAT PUBLIC HOSPITALS WITH MOUNTING CASE-LOADS OF

AIDS PATIENTS ARE BEING SHUNNED BY YOUNG HEALTH PROFESSIONALS AS
PLACES To COMPLETE THEIR FORMAL TRAINING, THAT'S A VERY BAD

SIGN,


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  I NOTE THAT THE STATE OF NEW YORK IS SENDING A VERY STRONG

MESSAGE TO YOUNG PHYSICIANS WHO REFUSE TO TRAIN IN SUCH

INSTITUTIONS, THAT MESSAGE IS em. IF YOU SEE NO ROOM ON YOUR

PRACTICE FOR PERSONS WITH AIDS, THEN THE STATE SEES NO ROOM FOR

YOU AS A LICENSED PRACTITIONER,

   THIS ISSUE IS FURTHER COMPLICATED BECAUSE AIDS-RELATED

ILLNESSES ARE OFTEN PROTRACTED .,, AND THEY ARE TERMINAL, THE

PERIOD BET\.IEEN DIAGNOSIS AND THE DEATH OF THE INDIVIDUAL MAY

LAST 18 MONTHS OR MORE,


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NOW, WITH THE DEVELOPMENT OF NEW LIFE-EXTENDING DRUGS, SUCH

AS A,ZaTm, THE COURSE OF SUCH DISEASES MAY RUN'EVEN LONGER,

  THESE AIDS-RELATED ILLNESSES ARE ALSO EXTREMELY DEBILITATING

AND REQUIRE CARE THAT IS VERY LABOR-INTENSIVE, HENCE, WE'RE

GOING TO COUNT ON THE UNQUALIFIED COMMITMENT OF ALL HEALTH
PROFESSIONALS TO GET US THROUGH THE NEXT DECADE OR TWO, AS THE *

AIDS EPIDEMIC EXPANDS,

  I DOFd'T HAVE TO TELL YOU THAT ALL OUR PROJECTIONS AS TO THE

FULL BURDErd OF CARE FOR PERSOFJS WITH AIDS FOR THE REMAINDER OF
THIS CENTURY TAKE FOR GRANTED -- AS I BELIEVE'THEY'SHOULD -- THE

PRESENCE AND THE INVOLVEMENT OF THE ENTIRE HEALTH COMMUNITY,


                   Q/
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WE HAVE NO BUSINESS PLANNING FOR ANYTHING LESS THAN THAT amu

AND HEALTH PROFESSIONALS HAVE NO BUSINESS PROVIDING ANYTHING LESS

THAN THAT.

  AS A PHYSICIAN, I AM PROUD TO BE PART OF A TRADITION OF

CARE THAT WILL NOT ABANDON THE SICK AND THE DISABLED a 8, WHOEVER

THEY ARE, I CERTAINLY.AM NOT ALONE, WHAT'S MORE, I'M SURE I AM

PART OF THE GREAT MAJORITY OF MY PROFESSION,

  NEVERTHELESS, I REGARD AS EXTREMELY SERIOUS THE REPORTS OF A

FEW PHYSICIANS AND OTHERS WHO ARE WITHHOLDING CARE FROM PERSONS

WITH AIDS mu, OR -- WORSE -- PERSONS SUSPECTED OF CARRYING THE

VIRUS, SUCH CONDUCT THREATENS THE VERY FABRICaOF HEALTH CARE

HERE AND EVERYWHERE ELSE IN THE WORLD,


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  THE HEALTH PROFESSIONS ARE IrdDEED SHOULDERING THE LARGEST

SHARE OF THE RESPONSIBILITY FOR RESPONDING TO THIS DISEASE, BUT

WE ARE FAR FROM ALONE,  IN FACT, OTHER PROFESSIONS -- LAW,

BUSINESS MANAGEMENT, AND SO ON -- ARE BEING DRAWN IN AS WELL,

  AND ULTIMATELY IT WILL BE THE GENERAL PUBLIC ITSELF WHICH

WILL NEED TO SORT THROUGH MANY OF THE ISSUES AND COME TO TERMS

WITH THE LOGICAL AND ETHICAL CONCLUSIONS,

  AND AT THE TOP OF THE LIST, I'M AFRAID, IS THE ISSUE OF

COST: THAT IS, WHAT IS THE COST OF AIDS-RELATED PATIENT CARE 111

AND WHO SHOULD PAY?


27

  ORDINARILY THIS IS NOT AN ISSUE IN AMERICAN SOCIETY, OVER

THE PAST CENTURY WE HAVE EVOLVED A GENERAL NATIONAL POLICY OF

DOING WHAT HAS TO BE DONE, RELATIVE TO THE HEALTH OF OUR PEOPLE,

AND OF PAYING FOR IT OUT OF GENERAL TAX REVENUES ml* FEDERAL,

STATE, AND/OR LOCAL,

  IN THIS WAY THE AMERICAN TAXPAYER SUPPORTS MATERNAL AND

CHILD HEALTH PROGRAMS, FOR EXAMPLE, AND DIABETES COfdTROL AND

HYPERTENSION SCREENING PROGRAMS, TAXPAYERS ALSO SUPPORT PROGRAMS

FOR ALCOHOLICS, DRUG ADDICTS, AND SYPHILITUX


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  THESE PROGRAMS ALL SHARE A CERTAIN COMMON ELEMENT: THEY ARE
DESIGNED TO RAISE -- OR TO RETURN -- MEN, WOMEN, AND CHILDREN TO
A STATE OF GOOD HEALTH,

  THAT'S PROBABLY THE MAIN REASON THAT AMERICANS STRONGLY
SUPPORT SUCH PUBLIC HEALTH PROGRAMS, THE GOAL OF EACH ONE IS A

POSITIVE OUTCOME,

BUT THAT MAY ALSO BE THE MAIN REASON THAT BROAD, NATIONAL

SUPPORT FOR AIDS MILL BE MORE DIFFICULT TO ACHIEVE,

IMPOSSIBLE? NO, DIFFICULT? YES,


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AIDS IS DIFFERENT FROM THE OTHER PUBLIC HEALTH PROGRAMS I

MENTIONED BECAUSE, AFTER CONSUMING TENS OF THOUSANDS OF DOLLARS

WORTH OF MEDICAL CARE AND SOCIAL SERVICES me, THE AIDS PATIENT

DIES,

  IN OTHER WORDS, THE COMMITMENT OF THE AMERICAN PEOPLE MUST
BE TO HELP PAY PART -- AND SOMETIMES ALL -- OF THE COSTS OF CARE

FOR WHAT IS ESSENTIALLY A TERMINAL ILLNESS

WHAT KINDS OF AIDS-RELATED COSTS ARE WE TALKING ABOUT?


30

  A NUMBER OF COST SURVEYS HAVE BEEN DONE, AND WE HAVE, AS A
RESULT, SOME SPECIFIC EXAMPLES OF COSTS OR RANGES OF COSTS,

NOTHING IS PRECISE, YET a,, BUT EVERYTHING IS CERTAINLY
INSTRUCTIVE,

  FOR EXAMPLE, A RECENT SURVEY INDICATES THAT, IN 1985, IT
COST ABOUT $635 A DAY TO PROVIDE INPATIENT CARE TO A PERSON WITH
AIDS IN A PUBLIC HOSPITAL, HOWEVER, THE HOSPITAL GOT BACK --

MAINLY FROM MEDICAID -- ONLY $482, FOR A NET DEFICIT OF $153,


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  THAT'S FOR ONE DAY o, FOR ONE PATIENT, MULTIPLY THAT

NUMBER BY THOUSANDS -- OR EVEN TENS OF THOUSANDS -- AND IT IS

CLEAR THAT THE AMERICAN PEOPLE MUST COME FORWARD WITH A GREAT

DEAL OF MONEY, AS THE AIDS EPIDEMIC EXPANDS,

  CURRENT ESTIMATES PUT THE COST OF PATIENT CARE AT ABOUT A

BILLION DOLLARS, THAT INCLUDES ALL DIRECT AND PERSONAL MEDICAL

COSTS.


32

  THERE ARE, IN ADDITION, ABOUT ANOTHER HALF-BILLION TO A

BILLION DOLLARS IN NONPERSONAL COSTS, MAINLY FOR GOVERNMENT

SERVICES SUCH AS DRUG AND VACCINE RESEARCH, PUBLIC EDUCATION,

SCREENING AND TESTING, AND SO ON,

  IN A COUPLE OF YEARS, THESE COMBINED COSTS ARE EXPECTED TO

CLIMB TO SEVERAL BILL ION DOLLARS . . , DOLLARS THAT, FOR THE MOST

PART, THE AMERICAN TAXPAYER MUST PROVIDE,

  THERE ARE ADDITIONAL SOCIAL COSTS, SUCH AS LOST HUMAN

CAPITAL, AND THESE ARE OFTEN TRANSLATED AS LOST WAGES AND

PRODUCTIVITY,


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  HOWEVER, SINCE WE KNOW SO VERY LITTLE ABOUT IV, DRUG

ABUSERS, FOR EXAMPLE, I HESITATE ADDING AN AUTOMATIC, FORMULA-

GENERATED FIGURE OF MANY BILLIONS OF DOLLARS OF LOST
PRODUCTIVITY PER.YEAR BECAUSE OF IJ, DRUG ABUSERS WHO'VE BEEN

INFECTED BY THE AIDS VIRUS,

  BUT EVEN IF YOU PUT TO ONE SIDE THESE INDIRECT SOCIAL COSTS;

WE WILL STILL FACE, IN THE YEAR 1991, A NATIONAL BILL OF $3-TO-$5

BILLION FOR THE COST OF AIDS-RELATED CARE -- BOTH INPATIENT AND

OUT-PATIENT, HOSPITAL AND HOSPICE,


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THESE COSTS WILL BE INCURRED BY AN ESTIMATED 145,000 PERSONS

WITH AIDS \JHO WILL BE IN VARIOUS STAGES OF A TERMINAL ILLNESS,

THIS IS AN OVERWHELMING FIGURE AND I DOUBT THAT THE AMERICAN

PEOPLE HAVE COME TO TERMS WITH IT YET,

  BUT THIS IS NOT JUST AN ISSUE FOR THE GENERAL PUBLIC,  IT'S'

AN ISSUE FOR ALL OUR PROFESSIONS AS WELL,


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CLEARLY, THE HEALTH PROFESSIONS MUST DO A GREAT DEAL MORE TO

DEVELOP ALTERNATIVE, LESS COSTLY, BUT HIGHLY EFFECTIVE WAYS TO

CARE FOR AIDS PATIENTS, WE NEED TO DO THIS IN LIGHT OF THE

SPECIFIC AIDS-RELATED DISEASES AND CONDITIONS WE KNOW ABOUT AND

THE DIFFERENT STAGES THROUGH THEY PROGRESS,

THIS WILL BE A NEW APPROACH TO MEDICAL CARE FOR SOME OF US:

MUCH OF THE TIME WE HAVE A GENIUS FOR INCREASING THE COST OF CARE

FOR ALMOST EVERYTHING,

  THE CHALLENGE TODAY, HOIJEVER, IS TO REVERSE THAT INCLINATION

AND GIVE THE COUNTRY -- AND THE WORLD -- A WAY OF CARING FOR AIDS

PATIENTS WITHOUT AN ESCALATION OF COSTS AND THE CONSEQUENT

BANKRUPTING OF THE NATIONAL TREASURY,


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SO IT WOULD SEEM THAT SOCIETY IS GOING TO NEED A STRONG AND

UNQUALIFIED COMMITMENT FROM ITS HEALTH PROFESSIONALS TO CARE FOR

THE RISING CASE-LOAD OF PERSONS WITH AIDS 11, REGARDLESS OF WHO

THEY ARE AND HOW THEY BECAME INFECTED,

  WE WILL ALSO NEED THEIR COMMITMENT TO CARE FOR SUCH

PATIENTS, WHO WILL BE, FOR THE MOST PART, IN VARIOUS STAGES OF

TERMINAL ILLNESS,

  AND WE WILL NEED THEIR COMMITMENT TO PROVIDE QUALITY CARE

FOR SUCH PATIENTS ,a, REGARDLESS OF THE METHOD -- OR LEVEL -- OF

REIMBURSEMENT,


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   I HAVE NO DOUBT BUT THAT SUCH CARE WILL BE PROVIDED, WE

WILL NOT ABANDON THESE PATIENTS, HERE IN THE UNITED STATES,

THAT'S SIMPLY OUT OF THE QUESTION,

  BUT I ALSO HAVE NO DOUBT THAT, FOR US, THIS EPIDEMIC OF AIDS

-- THE WAY IT RUNS ITS COURSE OVER THE NEXT FEW YEARS -- WILL

PROVIDE ONE OF THE MOST SERIOUS TESTS OF SOCIAL AND POLITICAL

WILL THAT OUR SOCIETY HAS EVER UNDERGONE,

I FIRMLY BELIEVE WE WILL COME THROUGH SUCH A TEST WITH OUR

IDEALS AND OUR INSTITUTIONS FULLY INTACT,