{"id":5739,"date":"2008-03-20T16:05:06","date_gmt":"2008-03-20T21:05:06","guid":{"rendered":"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/index.php\/2008\/03\/20\/how-to-solve-at-least-one-part-of-the-health-care-mess-adap-for-all\/"},"modified":"2008-03-20T16:05:06","modified_gmt":"2008-03-20T21:05:06","slug":"how-to-solve-at-least-one-part-of-the-health-care-mess-adap-for-all","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/how-to-solve-at-least-one-part-of-the-health-care-mess-adap-for-all\/2008\/03\/20\/","title":{"rendered":"How to Solve at Least One Part of the Healthcare Mess: ADAP for All"},"content":{"rendered":"

The presidential elections have once again made our Byzantine healthcare system <\/a>a regular feature in the news<\/a>.\u00a0A <\/a>recent film<\/a> also made quite a splash, and though Michael Moore offered no plausible solutions (Cuba? c’mon!), he certainly made me wonder what I’d do if I had two severed fingers\u00a0that needed to be\u00a0reattached and only enough money to cover one procedure.<\/p>\n

Everywhere, you hear\u00a0the usual complaints: increasing numbers of uninsured, highly variable (but mostly mediocre) quality of care, “skyrocketing” (interesting how often that adjective is used) costs, misaligned incentives leading to overuse of expensive procedures and medications, greedy insurers denying coverage, and (always) unfavorable comparisons with outcomes in other industrialized countries. Reading the<\/font> various <\/a>candidates’ solutions to this quagmire<\/a>, I get that same heavy-lidded feeling I had in medical school when lecturers tried to “explain” how the immune system works \u2014 yes, you have a theory and a lot of nice figures, but could anything so complicated really work? Many of those immunology theories have long since been discarded, and it would not surprise me a bit to see the same happen with the presidential hopefuls’ proposals.<\/p>\n

It is with great magnanimity, therefore, that I offer the candidates \u2014 free of charge \u2014 a model of how to fix one aspect of our healthcare mess, the high cost of prescription drugs.<\/p>\n

What we need is an AIDS Drug Assistance Program \u2014 ADAP \u2014 for everyone, and everything. Yes, ADAPs are far from perfect (4 states had ADAP waiting lists in the<\/font> <\/font>last year, some patients can’t get their $2000 viral tropism test paid for), but what they’ve accomplished is truly extraordinary. Some highlights:<\/p>\n