Health Care for Illegals?

Rep. Joe Wilson of South Carolina yelled "You lie!" at President Barack Obama after the President claimed that his health-care bill did not cover illegal immigrants. Actually, the bill bars coverage for illegals, but does mandate verification of legal status. Democrats have voted down Republican proposals for requiring verification. (1)

On September 15 the House of Representatives voted 240-179 to rebuke Wilson for his boorish interruption; Milwaukee Rep. Gwen Moore was one of only twelve Democrats to oppose the rebuke. I would have voted for it, if only to go on record against the pernicious decline in civility that has marred our public dialogues in recent years. Coincidentally, on the same day Iraq released the man who threw his shoes at President George W Bush last year . At least Wilson kept his shoes on.

But more important is the question of what to do if an illegal immigrant becomes sick or injured. Right now, anyone (legal or illegal) can seek treatment at a hospital emergency room, and the hospital must provide it (1). This is because we are a just and benevolent society, and so, we do not want people to spread infectious diseases or bleed to death just because they cannot pay for treatment or even prove they are in the US legally. The alternative of denying emergency medical service is unconscionable.

If a person does not pay his hospital bill, and collection efforts fail, the hospital writes off the loss and the cost is passed on to other patients, including those whose bills are covered by various government programs, such as Medicare and Medicaid. Since many illegal immigrants are very poor, we are already paying for their emergency care, one way or the other.

If the "public option" provision of the pending Healthcare Bill is enacted without verification of citizenship, it is likely that some illegal aliens will lie to the government to get coverage. If so, the hospitals that treat them will be reimbursed by the federal government, and the cost will not be passed on to other patients (except in the sense that they are also taxpayers). This will alleviate a vexatious problem for hospitals in areas with large numbers of illegal immigrants.

Although we should continue to treat the illegals when they get hurt or sick, there should be a penalty for lying to the government about their status. I would favor a system of random audits of people who have received medical benefits to determine if any of them are illegal immigrants; if any such are found, they should be deported. The risk of deportation would discourage illegals for applying for or using the federal health-care insurance, unless the need was extremely urgent.

But even if this modest amendment is rejected, the bill itself should still pass, because the benefits of establishing the public option (for the vast majority of uninsured who are American citizens) outweighs the drawback of possibly paying for the health care of some illegal aliens.

And that is no lie!
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(1) Myron Radke in the Your Opinions section of the Milwaukee Journal Sentinel of September 16, 2009, page 12A.

National Health Insurance

About 50 million Americans have no health insurance, which is why legislation now pending in Congress calls for establishment of a federal health insurance program. To see why this is a good idea, we must take a look at the uninsured:

A. The well-off
This group includes self-employed professionals, successful businessmen, and early retirees. These people could afford to buy private insurance, but would rather pay their own medical bills than deal with insurance claims. If all the uninsured were in this category, there would be no need for national health insurance.

B. Healthy Young Adults and Their Children
Since insurance companies compete for the business of this low-risk group, premiums would be relatively low. Yet, most of them are on tight budgets, and many would prefer to take their chances of getting sick or injured, rather than pay for insurance every month. Unlike Group A above, most of these people have little or no savings, so that when they do incur big medical bills (and every year some do), they declare bankruptcy. In fact, medical bills are the biggest single cause of personal bankruptcy in the US. When this happens, hospitals and clinics write-off the losses, and try to pass the costs along to other patients or to the government. This way, the burden of paying for their health care falls on others rather than themselves.

C. The Sick
Since there is no way to make any money insuring this group, health insurance companies typically reject applications from people with long-term illnesses ("pre-existing conditions.") Even those who qualify for Social Security Disability benefits must wait two years to qualify for early Medicare. If you are too prosperous for Medicaid, too young for Medicare and too sick for private health insurance, you will be uninsured.

Group C needs government health insurance more than anyone else. But if enrollment is purely voluntary, only sick people will sign-up for it. In this case, either the plan will cost the taxpayers a huge amount, or the premiums will be so high that sick people cannot afford them. Making insurance coverage mandatory is the only way to get members of Groups A and B above to enroll; their premiums will not only pay for their own medical bills, but also spread the costs of treating the chronically ill over a large enough population so that the costs can be affordable for all. The State of Massachusetts has done this, and today about 97% of state residents have health insurance.

Free-market advocates object to the government competing with private insurers, but the fact is that the fifty million uninsured either cannot or will not buy private insurance anyway. However, if the government- plan premiums are lower than those of private insurers (and they probably will be), the government plan will take some current customers away from private insurers. This is bad for these insurers, and may even drive some out of business, but it is good for the individuals and businesses that will save on their health-care costs. This saving can make American manufacturers more competitive in world markets, since most industrialized countries have some form of government health insurance, and this cost is not built-in to the costs of their products.

Libertarians will also bemoan the loss of personal freedom that mandatory health insurance will entail. But Americans are already required by law to "buy-into" Medicare and Social Security, and these programs would not have been successful if enrollment had been voluntary.

If we want all sick and injured people to have medical care available, it is only fair that everyone pay their share for this care. That is why I support mandatory health insurance for all Americans, with a government-sponsored option.