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The result of the monumental shifts in the structure and financing of health care delivery is that at the very time that medical innovations have made possible significant improvements in the quality and quantity of life for people with chronic illnesses, those who are responsible for paying for Americans' health care, in government and the private sector, seem to have finally said “Enough! We must cut costs, and cut them dramatically, and the simplest, most direct way of cutting costs is to deny coverage for certain kinds of treatments and certain kinds of illnesses.” People with HIV and AIDS are among those who are struggling, often unsuccessfully, for access to medically necessary treatment, but they are no longer alone. Millions of other Americans living with chronic disease face similar problems as they seek medical treatment that is effective, multi-faceted, and expensive in a health care system increasingly bent on controlling both the costs the structures of health care delivery. We thus stand at the threshold of a critical question: What lessons does the AIDS pandemic provide for American health care in general?