Immigration and Health
Yes, I all know good, red-blooded Americans hate immigrants. It even makes liberals squeamy. But honestly? If you pass stricter immigration laws and increase enforcement, you're not shooting yourself in the foot -- you're shearing both legs off with a chainsaw.
Existing immigration laws are already a problem for public health.* Not only do most illegal aliens face problems with being able to pay for care, but they also seek linguistic barriers and have legitimate fears about deportation. More stringent immigration laws - especially if combined with stronger enforcement - may make illegal aliens even less likely to seek health care. And what do we get with even more inconsistent health care? Even more ER closures and re-emergent, drug resistant infectious diseases! And hell hath no fury like a MRSA epidemic with 1 hospital per 500,000 people.
So is this just little ol' me being a crazy liberal again? Surprisingly, no: it's me being a very logical JD/MPH candidate.
1) Like 45 million Americans, illegal aliens are frequently uninsured and are ineligible for Medicare and Medicaid. Consequently, they are unable to afford consistent medical care. Inconsistent care leads makes it difficult to fully comply with drug regimens for infectious diseases. And an inability to effectively treat infectious diseases leads to drug resistant infectious disease. Although rich white Americans have been able to ignore ineffective treatment in the past because their status and geography effectively shielded them from any contact, modern globalization patterns make that increasingly impossible.
2) Despite medical education’s attempts to improve recruitment and training of diverse, multi-lingual medical providers, finding doctors fluent in foreign language can still be difficult in certain regions. This is especially true in rural regions like Iowa, which has a large number of illegal immigrants but virtually no doctors, let alone doctors who speak fluent Spanish. If a person can't explain their symptoms and their lifestyle to their doctor, how the hell can the doctor treat them?
3) Finally, and most importantly, illegal aliens are understandably afraid of medical officials. If you were an illegal immigrant who faced 1) constant racism, 2) deportation threats from government officials, 3) came from a country where medicine is intimately intertwined with the government, and 4) wasn't fluent in English, wouldn't you be afraid of wouldn't you be afraid to see a doctor? Hell, I'm a law student concentrating in health law at a T14 and even I don't know whether doctors are required to turn over identifying information to state and federal officials in every jurisdiction in every situation off the top of my head. Nor do I know when various agencies could and/or are required to share identifying information with other agencies.** Common law jurisdictions combined with state police and federal Commerce Clause powers are fun that way. (And I mean "fun" in the "cleaning your contacts in battery acid and then wear them for 12 hours" kinda way.)
Like all legal issues in common law, I could probably figure out what the relevant statutes, regulations, and cases are, which in turn would give me a pretty good idea about how my client's case would turn out. But it would take a while. If it takes an Ivy League-educated, native English speaking law student an hour or two on an absurdly expensive legal database to even find the relevant information for a specific situations, imagine how difficult it would be if you were an illegal immigrant without any of those advantages. If you don't happen to have $2500 on hand for a solo pracitioner's retainer, it would be damn near impossible.
So what does this mean? Illegal immigrants don't get health care. Who cares? They're not us, right? What happens to them doesn't hurt us.
Wrong.
Drug resistant infectious diseases are a concern, especially in an increasingly urbanized, globalized world. But that's obvious. What's not immediately apparent is how immigration interacts with health care infrastructure. As with uninsured Americans, both infectious and non-infectious chronic illnesses may be cost-effective to treat in early stages but ridiculously expensive in later ones. If you're facing three significant hoops for simple medical care, it's obviously more likely to get to the chronic stage. And as with uninsured Americans, the common understanding is that ERs have to treat everyone.
This is where the common debate breaks down. EMTALA requires ERs to stabilize uninsured patients -- not hospitals. Because no one compensates hospitals for the massive costs, hospitals are given a strong economic incentive to completely close ERs. The hospital, however, can remain open.
And that's where you really see immigration impacting the population as a whole -- even rich white male people. Even if we had universal single-payer insurance tomorrow, hospitals would still have an incentive to close ERs because such systems wouldn't compensate them for treating rising numbers of illegal aliens. As rich as Warren Buffet*** is, I'm pretty sure he'd still have a difficult time surviving a stroke if his ambulance had to drive through three counties.
But what really keeps me up at night is how drug-resistant infectious disease -- or a bioterrorist attack -- could combine with a lack of ERs to create an unprecedented shitstorm. And by "unprecedented shitstorm" I mean "makes Katrina look like a pleasant fall breeze."
I wonder if immigration advocates would be more successful in persuading liberals if they adopted the bioterroist/ER frame.
So here's a little experiment. I'm actually going to leave this post public so you can share it with your liberal-but-squishy-on-immigration friends. Let me know what happens.
(FYI: This is ordinarily a private LJ journal. Because of what I've seen on non-personal blogs, I'm going to moderate everything from strangers. And just so you know, I'm adopting the Twisty Faster and Angry Black Woman rules. This includes de-voweling and tracking you down in real life. Think it violates your First Amendment rights? Come talk to me after you've actually taken Con Law. Don't like it? Don't post.)
*Although, oddly, no one seems to write about the relationship between the two directly. I guess even the most liberal professors are legitimately afraid of being permanently blacklisted from the NIH's grant list.
**To be fair, I'm spending more time on international health issues these days than on domestic ones.
***My brother has been to his house in Iowa, but I'm not exactly sure where it is. I'm pretty sure it's not quite as rural as Grinnell, though.
Existing immigration laws are already a problem for public health.* Not only do most illegal aliens face problems with being able to pay for care, but they also seek linguistic barriers and have legitimate fears about deportation. More stringent immigration laws - especially if combined with stronger enforcement - may make illegal aliens even less likely to seek health care. And what do we get with even more inconsistent health care? Even more ER closures and re-emergent, drug resistant infectious diseases! And hell hath no fury like a MRSA epidemic with 1 hospital per 500,000 people.
So is this just little ol' me being a crazy liberal again? Surprisingly, no: it's me being a very logical JD/MPH candidate.
1) Like 45 million Americans, illegal aliens are frequently uninsured and are ineligible for Medicare and Medicaid. Consequently, they are unable to afford consistent medical care. Inconsistent care leads makes it difficult to fully comply with drug regimens for infectious diseases. And an inability to effectively treat infectious diseases leads to drug resistant infectious disease. Although rich white Americans have been able to ignore ineffective treatment in the past because their status and geography effectively shielded them from any contact, modern globalization patterns make that increasingly impossible.
2) Despite medical education’s attempts to improve recruitment and training of diverse, multi-lingual medical providers, finding doctors fluent in foreign language can still be difficult in certain regions. This is especially true in rural regions like Iowa, which has a large number of illegal immigrants but virtually no doctors, let alone doctors who speak fluent Spanish. If a person can't explain their symptoms and their lifestyle to their doctor, how the hell can the doctor treat them?
3) Finally, and most importantly, illegal aliens are understandably afraid of medical officials. If you were an illegal immigrant who faced 1) constant racism, 2) deportation threats from government officials, 3) came from a country where medicine is intimately intertwined with the government, and 4) wasn't fluent in English, wouldn't you be afraid of wouldn't you be afraid to see a doctor? Hell, I'm a law student concentrating in health law at a T14 and even I don't know whether doctors are required to turn over identifying information to state and federal officials in every jurisdiction in every situation off the top of my head. Nor do I know when various agencies could and/or are required to share identifying information with other agencies.** Common law jurisdictions combined with state police and federal Commerce Clause powers are fun that way. (And I mean "fun" in the "cleaning your contacts in battery acid and then wear them for 12 hours" kinda way.)
Like all legal issues in common law, I could probably figure out what the relevant statutes, regulations, and cases are, which in turn would give me a pretty good idea about how my client's case would turn out. But it would take a while. If it takes an Ivy League-educated, native English speaking law student an hour or two on an absurdly expensive legal database to even find the relevant information for a specific situations, imagine how difficult it would be if you were an illegal immigrant without any of those advantages. If you don't happen to have $2500 on hand for a solo pracitioner's retainer, it would be damn near impossible.
So what does this mean? Illegal immigrants don't get health care. Who cares? They're not us, right? What happens to them doesn't hurt us.
Wrong.
Drug resistant infectious diseases are a concern, especially in an increasingly urbanized, globalized world. But that's obvious. What's not immediately apparent is how immigration interacts with health care infrastructure. As with uninsured Americans, both infectious and non-infectious chronic illnesses may be cost-effective to treat in early stages but ridiculously expensive in later ones. If you're facing three significant hoops for simple medical care, it's obviously more likely to get to the chronic stage. And as with uninsured Americans, the common understanding is that ERs have to treat everyone.
This is where the common debate breaks down. EMTALA requires ERs to stabilize uninsured patients -- not hospitals. Because no one compensates hospitals for the massive costs, hospitals are given a strong economic incentive to completely close ERs. The hospital, however, can remain open.
And that's where you really see immigration impacting the population as a whole -- even rich white male people. Even if we had universal single-payer insurance tomorrow, hospitals would still have an incentive to close ERs because such systems wouldn't compensate them for treating rising numbers of illegal aliens. As rich as Warren Buffet*** is, I'm pretty sure he'd still have a difficult time surviving a stroke if his ambulance had to drive through three counties.
But what really keeps me up at night is how drug-resistant infectious disease -- or a bioterrorist attack -- could combine with a lack of ERs to create an unprecedented shitstorm. And by "unprecedented shitstorm" I mean "makes Katrina look like a pleasant fall breeze."
I wonder if immigration advocates would be more successful in persuading liberals if they adopted the bioterroist/ER frame.
So here's a little experiment. I'm actually going to leave this post public so you can share it with your liberal-but-squishy-on-immigration friends. Let me know what happens.
(FYI: This is ordinarily a private LJ journal. Because of what I've seen on non-personal blogs, I'm going to moderate everything from strangers. And just so you know, I'm adopting the Twisty Faster and Angry Black Woman rules. This includes de-voweling and tracking you down in real life. Think it violates your First Amendment rights? Come talk to me after you've actually taken Con Law. Don't like it? Don't post.)
*Although, oddly, no one seems to write about the relationship between the two directly. I guess even the most liberal professors are legitimately afraid of being permanently blacklisted from the NIH's grant list.
**To be fair, I'm spending more time on international health issues these days than on domestic ones.
***My brother has been to his house in Iowa, but I'm not exactly sure where it is. I'm pretty sure it's not quite as rural as Grinnell, though.