varjohaltia (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
varjohaltia) wrote2009-09-11 10:35 pm
varjohaltia) wrote2009-09-11 10:35 pm
Health Care Reform: Illegal Immigrants
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:
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.
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.
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.
no subject
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.)
no subject
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.
no subject
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!