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Tim Westmoreland: Transcript for “AIDS and the Underserved”

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Through the seventies, gay people did not want the government in their lives, because the government was only police and crime at that point. Um, but now in the early eighties gay people—well gay people need, gay people [as] the largest group in the HIV epidemic—gay people needed the government for help for the first time. And in many ways it was the humanizing of the gay movement at that point when people started, from the Congress people, started realizing that there were not just people who needed help with HIV, but that there were gay people in their district. It was the first time that they ever knew that. They thought everybody lived in San Francisco. I’m serious that people really were surprised that there were gay men in their districts. And here they were asking for something for the first time.

I know, well I know well one person who was fired from his Congressional job because he was gay. And he was closeted, but he was fired from his job. And when I started working on the Hill in 1979, I was one of two openly gay people in the whole Congress. There was one guy in the Senate and one in the House. I had the good fortune to sign on to work with Henry Waxman, who represented at that time, West Hollywood, um, and who was the lead sponsor of the Gay and Lesbian Civil Rights bill. And so coming out to Henry Waxman was, it was still a rough thing for me at that time. You know the homosexuality stigma was night and day different than it is today.

What I’ve said before is that AIDS crystallizes everything that’s a problem in the American health care system: lack of access, lack of ability to talk about things that are really at stake with your practicing doctor, lack of financing, lack of innovation, race and class distinctions in the health care system. It crystallizes things about gender relations, about the role of women, about the power relationship between men and women. It crystallizes, or it certainly did crystallize in the eighties and nineties, how America feels about gay people. It crystallizes how we feel about poor people. And everything that is a flaw in the American health care system is magnified and made completely clear when it comes to AIDS.

Ryan White has become an institution, Ryan White legislation has become an institution now. And I think it will continue to succeed as an institution for the reason that all successful legislation does, which is the members of Congress can see that it buys something for their constituents. Everybody has some Ryan White money, somehow, in their district at this point. And it becomes a point that elected members of Congress will defend because they can see that it’s buying services in their district, and it’s not just an abstraction that goes to somebody else. It’s something the governors want, because governors know that if the Ryan White money weren’t there they would have to raise tax money to pay for it in the state and local government, pay for hospital, hospital, extra hospital care for people who couldn’t get outpatient clinics services, and the same thing for local governments. So, Ryan White enjoys a more broad based support now than I could ever have anticipated 20 years ago, because it has been incorporated into fabric of how we pay for healthcare, and into the patchwork quilt of how we pay for healthcare in this country.

I have high hopes for health reform when it starts to kick in 2014. But it is quite clear to me that until we have thoroughly remade the system of health care, and not just the overlay of health finance, there will continue to be a role for Ryan White grants, um and all of this as the safety net under the safety net. I hope one day that everybody is fully insured and that we don’t need specialized grants programs, but that’s going to be a long time coming.