ACT UP Op-ed follow-up to Sen. Specter's office

The following letter was sent to Sen. Specter's office in follow-up to the op-ed published in the Philly Gay News.

ACT UP feels strongly that the public option is the most realistic and effective option to expand coverage. And while we realize that the Senate bill will pass this week without a public option or Medicare expansion, we also know the process is not over yet. We call for Sen. Specter and all our representatives to do everything in their ability to push for final conference legislation that looks more like the House bill. We realize that it is politically unlikely that a public option will make it out of conference, but now is the time for progressive politicians to stand up for what is needed: a public option and Medicare expansion.

While we acknowledge that the Senate bill does include important provisions to help expand coverage (around 30 million), we are very angry that there are not enough subsidies and cost containments in the Senate bill to make sure it is affordable. Again, we push for Sen. Specter to do all he can for cost supports to be adopted from the House bill to make sure people can afford it. The most politically unpopular thing, and jeopardizing in the upcoming primary, for Sen. Specter to do is to help pass legislation that pushes people to buy health insurance that they cannot afford.

We are also angry that the Senate bill has a quasi-mandate by penalizing people for not buying health insurance. This tactic is exactly what insurance companies want: no public option for competition, and forcing people to buy poor-quality private insurance plans. We are the only country in the world that has for-profit health insurance companies, and by the very definition they will continue to have a perverse profit incentive to exclude or minimize care to poor people and people who need it. We need a federal (not state-based) public option to keep insurance companies honest, and/or we need to forbid that companies make a profit on health insurance.

ACT UP is also angry that there are other concessions in the Senate bill to big industry and interests groups at the expense of consumers and people with HIV/AIDS. In particular, the Senate bill appeases to the wishes of Big PhRMA by ensuring that they will have a monopoly on biologics (or biotech) drugs and prevent cheaper generics from being produced. This a very big deal. Biologics are the cutting edge of new research and have some of the best prospects for innovative life-saving medications, and by excluding generics it will ensure that the lives of people with HIV/AIDS and others will be rationed for the sake of profit. The Senate bill also prohibits re-importation of cheaper drugs abroad, highlighting the hypocrisy that other governments have effective ways to negotiate for cheaper life-saving drugs while ours stands by and does nothing. ACT UP knows PhRMA's lies and greed quite well. PhRMA's argument for their record profits are that it is needed for R&D. This is a lie. Major pharmaceuticals spend more on advertising than R&D; much of the R&D and clinical trials are already done by the NIH, universities and other federal agencies; and pharmaceuticals mostly just produce second generation "copycat" medications to enforce new patent rights and delay generic competition.

This time around, there was a deliberate decision made by the administration to give PhRMA, AMA, hospitals, device manufacturers, etc. a free ride and include no pressure to reduce profits and costs imposed on consumers and taxpayers. This still needs to be done in future legislation, otherwise Medicare, and the country, will go broke. And the bigger issue is the need to change fundamental incentives in our health care system, that reward more procedures and treatments, rather than rewarding and prioritizing disease prevention and keeping people healthy. A practical example of this is requiring that routine HIV tests are covered under all public and private insurance plans, as early detection is key to early treatment and preventing further transmission. The Senate bill does not address this; the House bill, on the other hand, does and it also contains greater support for other prevention programs, including the creation of a prevention and wellness trust. No matter what happens, health care reform is far from over and there is still much to be done... but for now the House bill points to the better direction in the short and long-term.

As the op-ed said, though, there are also other areas that we are continuing to look for Sen. Specter to be a real leader on fighting for HIV/AIDS programs. We look for him to fight for more funding for HIV prevention programs, and particularly for dedicated funding for syringe exchange programs now that the ban has been lifted. Syringe exchange programs have been proven to be the cheapest and most effective way to reduce HIV and Hep C transmission. We, and others around the world, also desperately look for him to pressure President Obama to fulfill his promises and fully fund PEPFAR and the Global Fund.

Specter has an opportunity to further his legacy on fighting for people with HIV/AIDS, and we will continue to fight for him to do so.