Too often presidential commissions are long on advice but woefully short on real clout. Most AIDS watchers expected that Ronald Reagan’s 13-member AIDS panel, with its checkered beginnings and lack of expertise, would be no different. But no one counted on the no-nonsense leadership of retired Navy Admiral James Watkins. In releasing a hard-hitting 60-page report last week, Watkins politely but firmly dismissed the moralistic posturing that has characterized much of the White House’s response to the AIDS epidemic and outlined a realistic policy to control the spread of the disease. “We waste a lot of rhetoric and excessive time on a couple of little issues, while the forest behind us is burning,” declared Watkins. “We believe some major changes in course are necessary.”
Perhaps most striking was Watkins’ insistence that stemming the AIDS epidemic in the U.S. depends on providing treatment for the nation’s often neglected, mostly minority intravenous drug users. Although the rate of new AIDS infection among homosexuals has plummeted in recent years, the virus is spreading virtually unchecked among the 1.2 million addicts. Intravenous drug users now constitute a quarter of all AIDS patients in the U.S. Watkins noted that they are also responsible for 70% of heterosexually transmitted cases and AIDS cases among newborns. Yet only 12% currently receive help at treatment centers, where waiting lists run as long as six months. Says Watkins: “It is this group that poses the greatest long-term potential for spreading the AIDS virus.”
The admiral’s proposal to spend nearly $2 billion a year in federal, state and local funds to beef up the war on drugs is the strongest signal yet that the commission believes the IV drug problem, if left unchecked, could result in the spread of the AIDS virus to the heterosexual population. Equally important, Watkins has shrewdly sized up the role the country’s health- delivery system must play in combatting the devastation already caused by AIDS — and found it badly wanting. The chairman’s recommendations, which are expected to be approved by the full commission this week before going to the White House in March, outline how the U.S. health-care system should be restructured to meet the challenge of AIDS and other chronic diseases.
The forcefulness of Watkins’ proposals seemed to catch the Administration off guard. “We’ll have to look at the specifics,” said White House Spokesman Marlin Fitzwater. “We want a realistic assessment of what the problem is and how much it’s going to cost, and it sounds like that’s what they’re going to give us.” Says Domestic Policy Adviser Gary Bauer: “We wouldn’t dismiss anything just because of the cost.” Still, skeptics doubt whether the President or Congress will really use the ambitious blueprint as a guide. Watkins professes to be unconcerned. “It’s not in our charter to worry about the political impact,” he said. “There has not been a national strategy. The national policy is now being built.”
The campaign against AIDS as Watkins envisions it could cost more than $20 billion over the next decade. Among the 180 specific recommendations in the report: opening 3,300 new drug-treatment centers across the country that would provide 400,000 to 500,000 additional treatment slots. The commission would fund scholarship and loan programs to help attract doctors and nurses to ease crisis-level shortages that now exist, especially in poorer communities. The report also calls for doubling the AIDS review staff at the Food and Drug Administration in order to speed up the approval process for experimental drug therapies and hasten distribution to AIDS sufferers. By underfunding the FDA, charged Watkins, the Federal Government has relegated it to the status of an “orphan agency.”
His report contained one glaring omission: it failed to address the delicate question of prevalence testing for AIDS among the general population. Last December Watkins decried the lack of hard figures on the extent of the epidemic and promised to recommend action. For now, however, the admiral has tabled the issue, noting that it touches on counseling, civil rights and other legal issues that the commission has not yet tackled.
Even so, many believe credit for last week’s proposals is due less to the 13-member presidential panel than to Watkins and his staff. “They were hungry for our advice and recommendations,” recalls Martin Delaney, a San Francisco AIDS activist and one of 350 witnesses called to testify before the commission in the past few months. Some panel members, he notes, seemed to have no idea of what was going on or took every opportunity to defend current Administration policies. “I continue to get more and more pleased as I see what Watkins is doing,” says Dr. Mervyn Silverman, president of the Los Angeles-based American Foundation for AIDS Research. Democratic Congressman Henry Waxman of California, a critic of the Administration’s AIDS policies, declared that the proposals are a “first-rate set of recommendations that begin to deal with the AIDS epidemic responsibly and in detail.”
No less incisive was Watkins’ assessment of the nation’s health-care system. Fragmented and inefficient, it is “structurally and financially inadequate” to deal with the needs not only of AIDS patients but also of those with other chronic illnesses. The current nursing shortage, the most severe since World War II, threatens to overwhelm the system. More than 200,000 people will develop AIDS in the next four years. The price tag: $40 billion in medical costs alone. In addition, growing health-care demands will require 500,000 more nurses in the system by 1991. Watkins has called for more hospice programs and home-health-care alternatives to alleviate the strain of AIDS patients on clinics and hospitals. Although such steps will require immense government outlays, the investment may prove modest compared with the price of doing nothing.
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