Policies, Public Health Care, and the AIDS Epidemic

Sign 17- Who Owns Your Life?: Insurance and National Health Care, reverse side

Around the same time, insurance companies also began to refuse coverage of some advanced and expensive drug treatments in another move to attempt to reduce rising medical costs. The expensive treatments for cancer and AIDS, along with related expenses such as hospital stays, professional fees, and others are among those being challenged (Leary 1989). Sign 17- Who Owns Your Life: Insurance and National Health Care criticizes this system claiming “insurance companies can more or less choose whom to insure.” In the situation above, insurance companies are trying to reduce health costs by attempting to deny coverage of more expensive treatments (Leary 1989). As Kuoni questions “Who Owns Your Life?,” the health and lives of some patients are dependent on what and how much is covered by insurance or if they can even afford medical insurance or health care at all. This is also evident from The New York Times article cited on Sign 17- Who Owns Your Life: Insurance and National Health Care, which reported patients without medical insurance died at a higher rate than those with insurance (Associated Press 1991).

While these struggles over medical care costs were happening, New York City saw the spread of tuberculosis and HIV/AID. Municipal, state, and federal policy, budget, and tax decisions contributed to the spread of these diseases in the city. After the city’s fiscal crisis in the 1970s, the city was unprepared to handle the two epidemics. During this fiscal crisis, the Department of Health’s budget was cut by 20%, cutting staff, closing health centers and stations, and reducing programs. This left fewer facilities, less staff, and overburdened hospitals to control the epidemics (Freudenberg et al. 2006, 424-428). While other places places across the country had a surplus of beds, hospitals in New York City were overcrowded causing ambulances to be turned away and leaving patients waiting hours or days for beds to open up (Pabst 1988). Goldfarb notes many people with AIDS were among those who had long waits in the first comparison on Sign 27- Epidemics.

Sign 27- Epidemics, obverse side

In addition to closing health centers and clinics, in the 1970s, the city’s Department of Health also laid off most of its health educators and reduced health services to schools. This later inhibited the Department’s ability to communicate health information on HIV/AIDS effectively and delayed the establishment of HIV programs in city schools. One of the agencies that was eliminated was the Addiction Services Agency, which was responsible for substance abuse treatments. As the number of New Yorkers with drug addiction in the city grew, fewer were able to get treatment after treatment was transferred to state-funded programs. Though there were eventually increases in treatments, these increases were not enough for the influx in drug abusers who needed to receive treatment (Freudenberg et al. 2006, 427-428).

As the city struggled, the federal government turned down the mayor’s request for help. From the mid-1970s to the early 1980s, the federal government also made policy decisions and budget cuts which affected New York City. This included reductions in funding for urban development and public programs and reductions in federal support for low-income housing, forcing some people into homelessness. Homeless people were particularly vulnerable to tuberculosis and HIV/AIDS (Freudenberg et al. 2006, 431). Sign 27- Epidemics recognizes this connection and shares the fact that over 13,000 New Yorkers with AIDS were among the homeless.

Sign 27- Epidemics, reverse side

In an effort to restore its tax base after the fiscal crisis, the city offered developers tax incentives to convert single-occupancy hotels that once housed mentally ill patients into luxury condominiums and apartments. The AIDS Coalition To Unleash Power (ACT UP), a prominent AIDS activism group, and its Housing Committee planned protests at sites that benefited from these and other business developments. They also set themselves up outside the Department of Housing Preservation and Development and demanded to meet with a commissioner. This eventually pressured both the city and state governments to dedicate more funding for housing specifically for homeless people with AIDS (Carroll 2016). Like ACT UP, Goldfarb is critical of the tax abatements for corporations, which he expresses in the second comparison on the reverse side of Sign 27- Epidemics.

The year the Lower Manhattan Sign Project went up, 1992, HIV/AIDS became the number one cause of death for U.S. men between the ages of 25 and 44, and was the fourth leading cause of death for women (Center for Disease Control 1993). By 1994, it was the leading cause of death for all Americans between the ages 25 and 44. A few years earlier, in 1990, U.S. Congress enacted the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act to provide federal grant funding for HIV community-based care (U.S. Department of Health and Human Services 2016). In 1994, the Health Commissioner secured funding from the Ryan White CARE Act (The New York City Department of Health and Mental Hygiene, 60 and 63). By the late 1990s, deaths caused by HIV/AIDS were declining (Altman 1997). Sadly, in 1997, REPOhistory lost Ed Eisenberg, one of its founding members, to AIDS (Visual AIDS 2017). Eisenberg designed Sign 15- False Democracy.