Health Care Reform: Illegal Immigrants

[varjohaltia]

What follows can be considered political. Read at your own risk. Commentary is welcome, especially if my logic fails or I missed things.

I think the entire issue on illegal immigrants is entirely a red herring; there's no credible attempt to cover illegals anymore than they already are, if anything, the opposite -- which may be the wrong thing to do, see below.

Now, categorically I am in favor of only providing services to individuals with legal immigration (and otherwise, i.e. not having warrants, outstanding child support etc.) status. Basically, you get to enjoy services if you are paying the taxes that fund these services.

The problem with denying services to individuals who are not entitled to them is when the repercussions are worse then the original problem. Here are a few of the issues I see:

Deny Care to People Who Aren't Eligible

Assuming everyone is forced to buy insurance (hypothetically, I know this is a controversial point), you run into the eligibility requirement when selling said insurance, otherwise illegal aliens can just buy it like everyone else. All things considered, I think selling insurance to everyone would be the optimal outcome, ethically and financially. It goes against the sense of fairness, but it would mean that everyone getting care is pitching in and society would not be paying the price. But it's not that simple either, because...

Assuming everyone is forced to buy insurance, and you attempt to deny care to uninsured people, who by definition are doing something illegal, you run into more issues. Car insurance is mandatory. There are tons of people on the road that do not have it. Why would health insurance end up being any different? Then you have people who do not have proof of insurance with them, or there's a paperwork mix up, or their names do not match. This would most likely affect the poor most, as well as those individuals with names originating in languages with ortographies that do not have standardized transliteration to the Latin alphabet.

If you make medical care something people in dubious legal status are afraid to seek, they will not seek it. If health care providers are to report to law enforcement individuals with suspect status -- and law enforcement hardly has the resources to follow up on this as it stands -- you will end up with this result. The result is treatable conditions getting worse and resulting in permanent injury, death, and expensive ER care that society has to pay for.

Then you have the children of said demographic. Any policies would last about as long as it took for the first children to tragically die or get injured.

And all of the above is a moot point -- as long as medical professionals are even halfway decent people and have the Hippocratic oath, they will treat sick people -- and that's really the only sane way of looking at it that I can see.

Basically it boils down to this: The most effective way of keeping illegal immigrants from being a drain on social services of a society is to integrate them into society so they're contributing like everyone else. The problem of course is that doing so effectively rewards them for having broken the law. I have no idea how one deals with this dilemma.

Verifying Immigration Status

This is another issue entirely that is fraught with trouble. Iff every individual had an federal ID card or there was another single, consistent registry of all citizens, residents, and legal aliens, you could conceivably ask for said card at traffic stops and similar contacts. Since there is no such system, nor will there likely be, it is exceedingly difficult for an law enforcement officer to find out whether someone is in the country legally or not. Short of harassing "alien looking" or "funny speaking" individuals there is no way of enforcing immigration status without demanding that citizens, residents and legal aliens can always provide proof of their legal status on demand. Without placing unacceptable restrictions on the freedoms of legals, there's no surefire way to catch illegals.

Comments

[silvertales.livejournal.com]

Just a few things as I see them, since you are inviting commentary.

As the bill currently stands, people would be REQUIRED to purchase the government option health care with a fine of UP TO $3600 for not doing so, oh, and you'd have to buy it anyway... once you got done paying the fine. This is supposedly "offset" by the up to $6000 tax credit for those making less than $60,000, which are, presumably, the people who can't currently afford insurance. No one has clarified exactly WHERE that tax credit is supposed to come from, either.

The number of uninsured in this country is rather dishonest to begin with. At least 15% of those uninsured are those who CHOOSE not to purchase insurance for whatever reason. Either they: are wealthy enough to pay out of pocket for whatever they require only when they require it, or they choose to believe that since they have no pre-existing conditions they don't need it (or would rather have the brand new shiny iPod.) Its not real bright, but its their perogative and no one should tell them they HAVE to buy into this program if they don't want to.

Also, there is a whole great big blurry line being argued here regarding health CARE vs. health INSURANCE. There is no denial of health CARE to anyone who requires it. It is a legal requirement of public hospitals to treat those in need of health care. Now, you may have to wait your turn if you're not bleeding out of every orifice, but you WILL be treated regardless of lack of insurance, immigration status, and/or ability to pay.

The immigrant issue is a whole confusing, convoluted, and very touchy issue in and of itself. You make a very good point that some in this argument fail to realize and that is that illegal immigrants are, in fact, a drain when they take advantage of the system, but don't contribute to it (ie, health care, public education, etc.) So, what do you do about it?

No one really has a good solution to that problem, at least none that aren't being viewed as "barbaric" such as closing the borders, or actually enforcing immigration policy of deporting those who are caught here when they have violated the law. In some cases, it is city/county policy to ACTIVELY deny cooperation to border patrol and immigration services when looking for illegals. For instance, the cities of LA and SF have made it governmental policy to deny law enforcement cooperation to any federal authorities looking to crack down on illegal immigration or to even investigate questions of illegal immigration. Of course, they are in violation of federal law, which in this case, trumps the hell out of city and state laws since immigration is the purview of the federal government and states don't actually have the right to determine how they decide to handle issues of immigration. But, then again, no one is enforcing THAT either.

I don't know the answers to any of these questions, but I'm not real confident than the current administration does, either. Frankly, I'd rather they concentrate on things like fixing the economy they've run into the ground with rampant pork-filled, lobbyist-fueled spending we can't afford, increasing unemployment, damaging domestic economic policies like cap-and-trade and fix our relationships with the allies they've managed to piss off in the last 6 months before they even attempt to tackle something like health care.

Personally, I'm opposed as hell to Obamacare for my own raft of reasons I won't get into.

And I seem to have hijacked your lj..... sorry! *slinks off back under her rock*

yeah, I'm pretty passionate about this issue....

[varjohaltia.livejournal.com]

Well, it seems I end up discussing the merits of some aspects of the current plan after all :-)

First, there are a fair bit of major question marks about it, specifically what, how much, and from where. That being said, I do believe "someone ought to do something."

The problem with people who elect not to buy insurance is that they also make us pay for their care -- someone has to make up all the ER expenses that go to treat the uninsured. Actually, this also extends to underinsured; once the insurance decides to drop you or not cover something expensive you need, unless the cost can be recovered from your assets and future earnings, the care provider ends up absorbing the cost and passing it on.

Requiring everyone to carry insurance reduces the actuarial risk on insurance providers, allowing them to theoretically offer cheaper, better insurance to everyone since the risk is pooled better -- at the price of everyone being forced to buy a product, and thereby infringing on freedom (see car insurance). So again, you're hosed either way. Either people can be irresponsible and hurt others by their irresponsibility, or the government can (try) to force them to be responsible. Someone is always going to hate one extreme or the other. (I'm not going to go into the whole issue of "what kind of insurance" because that to me looks like a really nasty devil hiding in the details and this whole issue spirals into the realm of PhD dissertations.)

[silvertales.livejournal.com]

I'm certainly not saying something shouldn't be done. Believe me, at what I pay out-of-pocket for my health insurance, I'd be thrilled if something could be done to fix the exorbitant costs of health insurance.

That said, I DON'T think the federal government is the one to run it. The federal government has yet to demontrate it can administer ANYTHING with any amount of success without running it into the ground (as far as federal spending programs go). We have plenty of examples to choose from: Social Security: broke, Medicare/Medicaid: broke, Freddie Mac&Fannie Mae: broke, Indian Health Service: broke and a pathetic excuse for a health care system run COMPLETELY by the federal government, USPS: broke and subsidized by private money, Amtrak: broke. The list goes on and on.

And if anyone believes this program can be implemented without raising taxes or a decline in the quality of care, then they are living in a fantasy land.

I don't trust the federal government with my money, and aside from delivering the mail, protecting the borders, and collecting taxes, they need to stay the hell out of my life.

I agree something needs to be done, but this is not it.

[elgordomagyar.livejournal.com]

One would think the insurance industry's actuarial staff would make prudent decisions, and if they were actuaries managed by actuaries then I would agree with you. Rates would fall with the drastic reduction of the adverse selection problem.

However with almost two decades in the insurance industry I can assure you that's just not the reality we live in.

In our reality its not the people with the proper technical skills (underwriters and claims adjusters) directing the company but lawyers, accountants, and marketing shmos, the people who should never run anything but legal teams, accounting teams, and marketing/advertising. An argument can be made that most companies in North America, and increasingly in the EU/Australia/New Zealand are that way, but that's entirely another can of worms.

Since I'm typing this during a commercial in the Gators game I'll skip the details and nail the punchline.

With marketing/legal/HR/and accounting weenies running insurance companies, there can never be a correction in rates. They will always find ways to further line their pockets or remodel insurance carriers as they think one should run not as was proven over a couple centuries since the first insurance company was founded in a Liverpool tavern.

Here in FL, because the L/A/M weenies are running the actuarial departments, instead of relying on proper actuarial tables established over decades of experience, they've all moved to saving a few bucks by using computer models offered by a small number of companies operating without adequate actuarial staff. So IT guys end up getting into the vacuum in the decision loop, and as much as I respect you Toivo and many IT folks, to be blunt y'all don't know fuck all about being an actuary, underwriter, or claims adjuster. Vice versa also applies to us as you well know.

So sayeth the man who can't even replace a hard disk drive by himself, even with written instructions complete with plenty of illustrations and pictures!

[practicesmiling.livejournal.com]

Well done!

[roguer.livejournal.com]

The interesting thing is that the new health care plan would not deny emergency health care to illegal immigrants - say, in an emergency room. As that's kind of been our thing here in the U.S., that's probably a good thing.

What people are touchy on is providing standard care to illegal immigrants...and it appears as though that is not on the agenda (I say appears, because the bill is roughly a billion pages long and written in legalese).

So we'll see. I've had, in the past two days, both fair and poor fortune in watching the health care debates: some reasonable, intelligent arguments back and forth, and then some mindless, sensationalist media bullshit that did nothing to further either cause, raise awareness, or dispel ignorance.

-Rog

[roguer.livejournal.com]

Forgot to mention: maintaining automobile insurance is NOT a federal requirement. It is a state law. In SC, for example, you are NOT required to maintain coverage; however, you face a "fine" (much smaller than the actual cost of insurance, of course, if you're a terrible driver) for failing to have coverage. A fine, but that's it.

It's bad enough that we have to pay EXTRA insurance to deal with un/under-insured motorists. But the thought of these extra people on the road? In South Carolina?

Scary.

-Rog

[varjohaltia.livejournal.com]

Well, that's the central problem: If you give people the freedom to do whatever they want, you run the risk that they hurt other people -- by running into them with their cars, by ending up sick and not having means to pay for their care, to name a few. So you take away some of that freedom for in the interest of the common good -- but how much, and how?
And yeah, that I have to pay insurance, and then more insurance to cover those who aren't paying their insurance really rather annoys me.