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A good question about insuring illegal immigrants
Posted by: McQ on Tuesday, January 09, 2007

Deb Saunders asks an excellent question:
If it's wrong for illegal immigrants to have drivers' licenses, why should the state provide them with health care? That's the conundrum that Gov. Arnold Schwarzenegger will have to address as, after vetoing bills to allow illegal immigrants to obtain drivers' licenses, he pushes his plan to provide health care to all Californians, including illegal immigrants.
What is different in principle here?

Schwarzenegger's comments on his health care plan can be found here. Saunders points out:
But Schwarzenegger was wrong when he said this about health coverage for illegal immigrants: "I don't think there is a question or debate that they ought to be covered." That argument was based on the fact that federal law already requires that hospitals provide emergency care for those who need it.

No one who needs emergency care can be turned away. So, Schwarzenegger extrapolated, providing nonemergency care is "realistic" and "not being in denial." "Realistic," according to the governor's office means that nearly 1 million undocumented workers will gain coverage if the package passes — 40,000 through their (illegal) jobs, 160,000 by purchasing individual coverage, and the remaining 750,000 would have their coverage paid for by the state. (Read: Your tax dollars.)
Quite an extrapolation, especially given the reasoning that says just because they want a driver's license, people who are here illegally don't have a right to one. But apparently, they do have a right to demand full health care benefits on the taxpayer's dime.

Dale covered this pretty well a couple of days ago when he pointed out:
Even more, is the fundamental tension between having a welfare state and open immigration. You can, if you like, have a welfare state. If so, you cannot have unrestricted immigration without bankrupting that state. Conversely, you may have unrestricted immigration, if you wish to forego having a welfare state.
Unrestricted immigration. Welfare state. Pick one.

And of course, there's also another underlying law of the universe which will go to work here. If you subsidize law breaking by rewarding it what do you suppose you'll get?

If California thinks that providing health care to illegal immigrants will in some way discourage more illegals from seeking residence there, I'd have to question their rationality. And, of course, the usual suspects will be footing the bill for this grand act of economic stupidity.

Who will pay for it?
Various lobbies already are fighting over who pays for the plan. Schwarzenegger wants businesses that employ more than 10 workers to provide health coverage or pay 4 percent of payroll into an "in-lieu" fund that will bankroll health care for their workers. Schwarzenegger also wants to tax hospitals — 4 percent of gross revenues — and doctors — 2 percent of revenues. Team Arnold argues that because Medi-Cal payments will increase, health-care providers can absorb the new tax.
Now, if you're an employer near the 10 employee mark what is the answer? Fairly easy. And who picks up the bill? Of course.

Secondly, what business ever "absorbed" any increases in fees ... the medical profession is no different?

And:
The rub: This is, as California Medical Association President Anmol S. Mahal put it, "a tax on those who are sick." The CMA also fears an exodus of employers from private benefit packages to the in-lieu pool— as the 4 percent fee just might save them money.
Of course it will. Econ 101.

They'll simply change the way they do business:
I fear that even at 4 percent, more employers will decide to hire off the books — which means illegal workers will continue to use the emergency room and hospitals will continue to pass costs onto those who pay for their health care.
They can also start using "contractors" (1099 "empolyees") to get under the 10 employee threshold.

But I digress and instead want to return to the original question above.
If it's wrong for illegal immigrants to have drivers' licenses, why should the state provide them with health care?
Anyone?
 
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Comments
The most persuasive reason I’ve heard is that if someone is carrying a communicable disease, you want them to get treatment, not spread it around. I know this is (probably) a somewhat narrow subset of what you are discussing, but it seems at least one instance in which treatment of illegals’ health is more important than driver’s licenses.
 
Written By: Sean
URL: http://www.myelectionanalysis.com
The most persuasive reason I’ve heard is that if someone is carrying a communicable disease, you want them to get treatment, not spread it around. I know this is (probably) a somewhat narrow subset of what you are discussing, but it seems at least one instance in which treatment of illegals’ health is more important than driver’s licenses.
And of course, one of the purposes of controlling immigration is to prevent the entry of just such people.

So it seems the best preventive care is through legal immigration.
 
Written By: McQ
URL: http://www.qando.net/blog
No arguments here on the need to control immigration into this country, and I’m not saying "providing illegals with health care" is the best way to solve the problem. I didn’t understand that to be your question. All I’m saying is that, once illegal immigrants get here, there is at least a straightfaced argument that there might be a headier state interest in making sure that they seek and receive basic medical care than in making sure they are granted a driver’s license. In other words, preventing a typhoid Maria might be more important than making sure that Juan isn’t licensed to drive.
 
Written By: Sean
URL: http://www.myelectionanalysis.com
I’m not saying "providing illegals with health care" is the best way to solve the problem.
I’m not inferring you are, Sean, I’m simply pointing out that it is an argument that deals with a problem after the fact when in fact a solution to the problem already exists that doesn’t involve giving illegals benefits to which they aren’t entitled.
All I’m saying is that, once illegal immigrants get here, there is at least a straightfaced argument that there might be a headier state interest in making sure that they seek and receive basic medical care than in making sure they are granted a driver’s license. In other words, preventing a typhoid Maria might be more important than making sure that Juan isn’t licensed to drive.
Of course giving Maria access to basic medical care doesn’t at all guarantee you will prevent a typhoid Maria since it is most likely the communicable disease slipped over the border illegally when had she shown up through the legal system, she’d have been diagnosed there.
 
Written By: McQ
URL: http://www.qando.net/blog
"The most persuasive reason I’ve heard is that if someone is carrying a communicable disease,"

All the more reason to control immigration. Does anyone remember the Public Health Service, or Ellis Island?

http://www.usphs.gov/html/history.html
 
Written By: timactual
URL: http://
Does anyone remember the Public Health Service, or Ellis Island?

Ahh. Panic in the Streets. Fond memories.
 
Written By: Achillea
URL: http://
Terrorists can make better use of driver licenses than they can of free medical benefits. Not that this makes either policy a good idea, just that one doesn’t really follow from the other. I’d say driver licenses for illegals would make sense only if (1) the licenses were clearly marked to identify them as illegals, or at least as chumps who can’t/won’t prove to the satisfaction of the DMV that they are here legally, or (2) illegals are entitled not only to health care, but to every other benefit under the sun that would normally be made available to citizens and legal residents.
 
Written By: Xrlq
URL: http://xrlq.com
why should California provide health care to illegal aliens?

A. Because it’s federal law. Last I checked, hospitals receiving federal funding, which include county hospitals providing Medicaid services, must treat everyone who comes to the door without questioning immigration status or ability to pay.

B. Because there aren’t the votes to deny emergency room care to those who cannot establish immigration status / ability to pay at admission. [Here’s one which hard libertarians need to explain to me. Do you really ever expect that this society will vote for a system in which those who cannot pay for emergency room care or aren’t carrying acceptable ID are kicked out of the ER? Is that a society you want to live in?]

C. Because enforcement of immigration law is vested virtually entirely in the federal government, which has shown virtually no interest in doing anything to dry up demand.

D. Because after a transition period, the evidence from other countries strongly suggests that having everyone with health coverage should be cheaper than the current system.
 
Written By: Francis
URL: http://
Because it’s federal law.
Yeah, and? This isn’t about law, it’s about principle. Murder was made retroactively legal once in Germany. OK with you?
Because there aren’t the votes to deny emergency room care to those who cannot establish immigration status / ability to pay at admission. [Here’s one which hard libertarians need to explain to me. Do you really ever expect that this society will vote for a system in which those who cannot pay for emergency room care or aren’t carrying acceptable ID are kicked out of the ER? Is that a society you want to live in?]
No one said you had to deny them care Francis. What we are saying is they should pay for it. Too much to ask?
Because enforcement of immigration law is vested virtually entirely in the federal government, which has shown virtually no interest in doing anything to dry up demand.
No question, no denial. Why should the CA taxpayer be further taxed to pay for that dereliction of duty?
Because after a transition period, the evidence from other countries strongly suggests that having everyone with health coverage should be cheaper than the current system.
At the cost of rationing, bad average service and interminable delays. In a free country we shouldn’t have to put up with that.
 
Written By: McQ
URL: http://qando.net
well, if you want to debate principles, let’s take another crack at it:

1. Immigration should remain the sole province of the federal government, in both making and enforcing the law. States should not be able to interfere with one of the most classic powers of the nation — the ability to control its borders.

2. The giant sucking sound Ross Perot was talking about exists, but he had the direction wrong. I’ve read that there is no other border in the world in which the median income differential is as large as it is between the US and Mexico.

3. Demand-side management is a hard problem. There is not much of a constituency for requiring employers to prove residency / citizenship status of their employees once people start to find out that doing so can be quite expensive. And considering there are substantial criminal penalties for employing illegals, employers also have 5th Amendment protections against some of the proposals that have kicked around.

4. Most illegals are a net gain to our society on pure financial terms. They pay sales taxes, their employers pay ss taxes and mostly they don’t make enough to pay a lot of income taxes. Meat, vegetables, houses, restaurant meals and hotel rooms are cheaper than they would otherwise be.

5. Emergency room care for those without insurance can be very expensive. People who are already living pretty close to the bottom of our society’s ladder tend not to have a lot of cash lying around. Even a relatively minor emergency can utterly devaste a poor family’s finances. You can’t get blood from a stone, and trying to do so is unnecessarily cruel.

6. Many people, both legal and illegal, use ER care as primary care. This is utterly insane. Truly sick and hurt people are forced to wait, and minor problems are allowed to turn into major ones.

7. The free-rider / gambling problem is unsolvable absent a universal mandate. A measurable percentage of people won’t buy coverage unless it’s mandatory, and a measurable percentage of them will need it every year. The only health care pool that makes any sense is everyone.

counter-points:

There is likely a direct relationship between a collapsing middle class in urban cores and illegal immigration. As a society we are creating our own crime waves by allowing illegal immigrants to take the trades-based jobs that should (for some value of "should") be going to city kids.

Everybody is under-pricing the true cost of universal insurance. The cost of bringing people into the system is not going to be cheap.

Simply issuing everyone an insurance card won’t automatically end the problems with over-crowded ERs.

my conclusion:

I am persuaded by the free-rider / gambling problem that some kind of mandatory policy is required. We as a society are not going to let people who gamble on not needing coverage to die in a park because they couldn’t afford the ER, even if they are here illegally. The price of living in a society of such raging empaths is universal health insurance. Only the government has the power to impose that obligation.
 
Written By: Francis
URL: http://
I am persuaded by the free-rider / gambling problem that some kind of mandatory policy is required. We as a society are not going to let people who gamble on not needing coverage to die in a park because they couldn’t afford the ER, even if they are here illegally. The price of living in a society of such raging empaths is universal health insurance. Only the government has the power to impose that obligation.
Short version: Coersion is the key and I’m up for giving the power to government to limit your freedom and your choices because I can’t think of an alternative to such a plan that doesn’t involve them.

See item one on my previous answer.
 
Written By: McQ
URL: http://qando.net
"Ahh. Panic in the Streets. Fond memories."

Jeez. I can barely remember having seen it(I hope it is a real memory), even after reading your link thinking about it.

******************************
"Immigration should remain the sole province of the federal government, in both making and enforcing the law. States should not be able to interfere with one of the most classic powers of the nation — the ability to control its borders"

Suppose some day we find out that a group of terrorists has indeed illegally entered this country. Not too big a stretch, I think. Are you saying that the correct attitude of local law enforcement agencies to this is "Sorry, that’s not my job, man"?
 
Written By: timactual
URL: http://
Timactual: stopping terrorism is always an appropriate role for local law enforcement. Having local law enforcement put immigration holds on people who are here illegally but aren’t involved in terrorism is much more likely to reduce cooperation from a community which could be a great resource in pointing out terrorists.

McQ:

premise 1: If health insurance is not required, some people won’t buy it.
premise 2: Some people who don’t have health insurance will at some point incur substantial medical expenses or die.
premise 3: Some of those people in group 2 will not be able to afford the expenses they occurred. Even if they don’t declare bankruptcy, they will essentially never be able to pay back what the hospital charged them.
premise 4: The size of Medicaid and the size of the uninsured population indicates that this is an enormous problem, not a small one. Huge numbers of people are gambling that they’ll never need expensive care. Huge numbers of people are being proven wrong and ending up on publicly-funded health care.

conclusion: As a society we have three choices: (a) literally let people die of accident and/or chronic but treatable illnesses, due to their inability to pay (call this the Death Option); (b) socialize the cost of treatment after the costs have been incurred (call this the Medicaid Option); or (c) require everyone to join the insurance pool and get more cash up front (call this the Mandatory Insurance Option).

I see no other alternatives. So, what do you choose: Death, Medicaid or Mandatory Insurance?

if your answer is none of the above, please explain where I went wrong.

[I’m also posting this comment in Dale’s post in case you want to answer there.]
 
Written By: Francis
URL: http://
Having local law enforcement put immigration holds on people who are here illegally but aren’t involved in terrorism is much more likely to reduce cooperation from a community which could be a great resource in pointing out terrorists.
I’d rather send back all illegals that LEOs catch, rather than wait for illegals to start acting as a resource in pointing out terrorists.

Right now, I know LEOs in L.A. can’t touch illegals. How much cooperation do we receive from illegals in L.A.?
As a society we have three choices: (a) literally let people die of accident and/or chronic but treatable illnesses, due to their inability to pay (call this the Death Option); (b) socialize the cost of treatment after the costs have been incurred (call this the Medicaid Option); or (c) require everyone to join the insurance pool and get more cash up front (call this the Mandatory Insurance Option).
In fact, in the old days doctors would treat poor patients at lower rates. The poor received the health care they needed, and it was effectively funded by the wealthy, who received the health care they wanted at a much higher price.

Also, health care costs are driven up by Medicare and employeer-provided health insurance. It is basic economics.

The best thing we could do with respect to health care is to go back to a real free market and pay as you go. Perhaps with some insurance for catastophic health conditions.
 
Written By: Don
URL: http://
A goodly part of the problem is when we started attributing ’constitutional rights’ to illegal aliens, and then started treating healthcare and other give-away services, as constitutional rights.

 
Written By: Bithead
URL: http://
" a community which could be a great resource in pointing out terrorists"

If that "community" wasn’t there, someone else would point them out. Why would they be any more of a resource than legal residents and citizens?

************************
"In fact, in the old days doctors would treat poor patients at lower rates."

Yep, or for free. They go to jail if they try that now.
 
Written By: timactual
URL: http://

 
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