December 1 is World AIDS Day. Every year, people around the world remember the early epidemic as a medical and moral tragedy, a time of too many funerals and too few medical breakthroughs. But the economic story — about how government abandonment led to the marketization of survival — is largely untold. That missing story matters, especially because its logic is resurfacing now.

In the early years of the AIDS crisis, when thousands of people were losing their jobs, housing, and health insurance, the American government didn’t intervene to stop the bleeding. Instead, a new, little-understood financial instrument emerged: people with AIDS began selling their life-insurance policies to investors for quick cash, often just to afford rent, medication, or a measure of comfort in their final months. An investor would pay a patient a portion of their life-insurance “death benefit” — maybe 80 percent of the policy’s value, maybe 30 percent, depending on how soon the patient was expected to die. After the patient’s death, the investor would collect the full insurance payout.

These transactions, called viatical settlements, were often portrayed as a macabre curiosity of the epidemic — a clash between “bankrupt” sellers and “morally bankrupt” buyers. Gawking anchors on corporate news shows found a new favorite word: ghoulish. But the viatical market wasn’t an aberration. It was a predictable outcome of austerity and abandonment, a textbook example of what happens when the social safety net is deliberately dismantled and private capital rushes in.