...[Bernie] Sanders seemed to be churning internally about something until, dispensing with ceremony, he blurted out: “Let me be blunt. Do any of you get money from the drug companies?”

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The question was met with an awkward silence. Most AIDS organizations do accept grants from pharmaceutical companies — in some cases large ones. It is widely seen as a symbiotic relationship. AIDS nonprofits depend on funding from drug companies; drug companies depend on the organizations to educate patients about their wares. That arrangement rankled Sanders, who views the pharmaceutical industry as a public menace. In the primary, one of his signature issues was support for California’s Proposition 61, a referendum that sought to control drug prices by barring public insurers from paying any more than the prices charged to the Veterans Health Administration, which traditionally gets a big discount. A few of the AIDS activists gathered in San Bernardino — along with a number of experts and patient groups — had strong reservations about the unintended consequences of that initiative. Some worried it would drain R.&D. budgets; others feared it would prod drug companies to jack up prices on veterans. Sanders did not share their reservations about Prop. 61. “Drug companies are ripping off the American people in a big way,” he said. “These are bad-news people, and they need to be taken on.”

Directors of health care nonprofits are traditionally cautious and courtly, fearful of choking the funding streams that issue from nit-picking grant committees and image-conscious donors. Weinstein, an ex-Trotskyite, is no courtier. He runs his organization as a “social enterprise,” meaning that it generates most of its revenue not from grants and fund-raising but from adjacent businesses. A.H.F.’s main business is a network of pharmacies and clinics that provide primary care to more than 41,000 patients in the United States, most of whom have their insurance claims paid by government insurance programs like Medicaid. The excess income from these patients helps the AIDS Healthcare Foundation provide free care to more than 700,000 H.I.V. patients internationally — the greatest reach of any AIDS organization. This prodigiously successful model has both insulated A.H.F. from typical funding woes and helped it to expand at an astonishing clip.

Over the last six years, A.H.F.’s budget has grown from $300 million to more than $1.4 billion, about the size of Planned Parenthood. If their projections hold, it will reach $2 billion by 2020, giving A.H.F. — a private entity effectively under the control of one man — a budget nearly half the size of the World Health Organization’s.

To his many critics in AIDS activism, Weinstein is the Koch brothers of public health: a mastermind driven by ideology, accountable to no one, with bottomless funds and an agenda marked by financial opportunism and puritanical extremes. It doesn’t help that A.H.F. has been the subject of near-constant litigation and complaints for questionable business practices, including union-busting, giving kickbacks to patients, overbilling government insurers and bullying funders into denying grants to institutional rivals. (A.H.F. has denied these accusations.)

On paper, 2016 was Weinstein’s best year ever. He opened six new pharmacies and one clinic in the United States and started new programs in Indonesia, Bolivia and Zimbabwe. But on the advocacy side, he suffered significant setbacks. In November, his drug-pricing initiative failed. So did his condoms-in-porn initiative, despite the fact that he had managed to pass a similar law in Los Angeles County in 2012. Most recently, on March 7, voters in the city of Los Angeles resoundingly rejected, by a 2-to-1 margin, his quixotic anti-density measure. The public, it seems, is not on board with Weinstein’s agenda.

Read the source article at The New York Times

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