Health Care Politics Thread

Prime Junta said:

This is a bit of a tangent, but I thought it'd be interesting to hear what especially "frog-march-em-to-the-border" dte thinks of this particular bleeding-heart illegal immigration story:

[ http://www.nytimes.com/2009/05/04/nyregion/04immigrant.html ]

Salient points:
* Chinese illegal immigrant, who is mentally ill, and unable to either defend herself in immigration court or obtain travel documents needed for her deportation.
* Been in jail for about a year.
* Suffered abuse in China before coming to the US.
* Likely to die fairly soon if no-one intervenes.
* Her sister (presumably in the country legally) has offered to swap places with her to save her life.

So, dte -- what would you do? Put her on a rowboat in LA and point her west? Something else, what?

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You left out a salient point, PJ.

after noting that a government psychiatrist had deemed her competent to participate in the hearing.

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I don't suppose you're doubting the quality and capability of government-supplied health care, are you?

It's a sad story, but as I understand the immigration laws, she has to say one word: "Asylum". Say that word and her case goes thru different channels which might be better able to deal with her unusual circumstances. But let's skip that detail for now. How did she get sick in the first place? Breaking the law in China. We can debate the one child rule if we so desire, but it's the law of the land over there. So she breaks Chinese law, then runs to avoid prosecution, then breaks the law repeatedly in the US. In the end, if you move outside the legal system, you don't get to demand the protections it affords. So, yes, I put her on a plane and let the Chinese known they've got someone that needs help coming their way.

dteowner said:

You left out a salient point, PJ.
I don't suppose you're doubting the quality and capability of government-supplied health care, are you?

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Oh, I have lots of doubts about the quality and capability of health care that *your* government supplies, no doubt about that.

Anyway, thanks for the response. It's filed away for future reference...

Rithrandil said:

It's really easy to ditch out on an ER bill or get it comped if you're low income.

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...and have no repossessable property. However, if you're, say, unemployed and therefore have no income, but still own your house, they will take your house first.

Illegals don't have any ID and just give fake names/addresses/social security numbers anyways.

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True.

dteowner said:

It's a sad story, but as I understand the immigration laws, she has to say one word: "Asylum". Say that word and her case goes thru different channels which might be better able to deal with her unusual circumstances. But let's skip that detail for now. How did she get sick in the first place? Breaking the law in China. We can debate the one child rule if we so desire, but it's the law of the land over there. So she breaks Chinese law, then runs to avoid prosecution, then breaks the law repeatedly in the US. In the end, if you move outside the legal system, you don't get to demand the protections it affords. So, yes, I put her on a plane and let the Chinese known they've got someone that needs help coming their way.

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I have to agree with dte here - I lived most of my life in an area where you can completely feel the effects of illegal immigration. California's school systems and hospitals are largely failing due to the massive tax burden of having to educate/care for illegal aliens or their anchor babies. If we're supposed to take care of these people then their home countries should be billed for our expenses, IMO. Otherwise, give them life saving medical treatment, then put them on a plane to their country or escort them across the border in handcuffs.

Prime Junta said:

...and have no repossessable property. However, if you're, say, unemployed and therefore have no income, but still own your house, they will take your house first.

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Our hospitals also have readily available 'charity care'. I got offered the entire 140k hospital bill I racked up for about 29 days of the worst bed and breakfast I had ever been in, and I refused to accept it. I got it because I didn't have any income/etc/etc, even though my parents claimed me on their taxes.

Rithrandil said:

I have to agree with dte here - I lived most of my life in an area where you can completely feel the effects of illegal immigration. California's school systems and hospitals are largely failing due to the massive tax burden of having to educate/care for illegal aliens or their anchor babies. If we're supposed to take care of these people then their home countries should be billed for our expenses, IMO. Otherwise, give them life saving medical treatment, then put them on a plane to their country or escort them across the border in handcuffs.

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You know, in theory I'd agree with you.

In practice, though, I don't.

The reason is that illegal immigration has been a feature of the American economy for so long that it's no longer possible to unmake that omelet: doing so would create more injustice than it solves. For example, their children born in the USA are legally Americans, so you'd be faced with a choice between deporting American citizens or sticking the whole mess of 'em in orphanages, which is a bit of a non-starter IMO.

In a way, this is a bit like the Palestinian refugee problem -- in theory, they should be able to return to their homes, but in practice it's not possible without creating a big ol' cascade of further injustice.

IOW, I believe that in both cases some other, better solution has to be found, and in neither case is there a solution that's going to be free of cost and will please everybody. My instinct would be to regularize the whole lot of them, perhaps under some entirely new visa category, and then make sure the situation doesn't start all over again. That way you could tax them so they'd do their bit to pay for the services they're consuming, as well as enforce minimum-wage rules and what not.

Of course, if Mexico wasn't dirt poor and ridden with the swine flu, it'd be great if they could chip in.

(In the EU, by the way, if, say, a Romanian gets sick in Finland, Finland will bill Romania for the health care s/he receives. It works reasonably well.)

Prime Junta said:

You know, in theory I'd agree with you.

In practice, though, I don't.

The reason is that illegal immigration has been a feature of the American economy for so long that it's no longer possible to unmake that omelet: doing so would create more injustice than it solves. For example, their children born in the USA are legally Americans, so you'd be faced with a choice between deporting American citizens or sticking the whole mess of 'em in orphanages, which is a bit of a non-starter IMO.

In a way, this is a bit like the Palestinian refugee problem -- in theory, they should be able to return to their homes, but in practice it's not possible without creating a big ol' cascade of further injustice.

IOW, I believe that in both cases some other, better solution has to be found, and in neither case is there a solution that's going to be free of cost and will please everybody. My instinct would be to regularize the whole lot of them, perhaps under some entirely new visa category, and then make sure the situation doesn't start all over again. That way you could tax them so they'd do their bit to pay for the services they're consuming, as well as enforce minimum-wage rules and what not.

Of course, if Mexico wasn't dirt poor and ridden with the swine flu, it'd be great if they could chip in.

(In the EU, by the way, if, say, a Romanian gets sick in Finland, Finland will bill Romania for the health care s/he receives. It works reasonably well.)

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Yes - see, I don't think we can just round up all 12 million plus or minus the legal children and throw them in buses back to Mexico. I think the solution we need to do is ramp up border security (not with a fence) and make it much harder to physically enter the U.S. Then, we need to go after employers who knowingly employ illegal aliens while simultaneously increasing the number of guest worker programs (most people in the Agriculture business would be completely fine with this - illegal aliens working in the fields make a few dollars above minimum wage). Then we need to do whatever we can to help prop up Mexico.

If you do these things, you'll limit the number of people physically able to enter the U.S., you'll make it harder for those here illegally to find work, and you'll make less people want/need to come to the U.S. to find work. Illegals will end up deporting themselves to head back home.

I am just 100% a blanket amnesty. We did that in the 80s and did two things: jack and shit. It's also frustrating because about 7 states bear the burden of illegal immigration and the other 43 reap the benefits in terms of cheap produce, etc etc. If anything California should be billing Vermont or Maine for the costs, heh.

Rithrandil said:

I am just 100% a blanket amnesty. We did that in the 80s and did two things: jack and shit. It's also frustrating because about 7 states bear the burden of illegal immigration and the other 43 reap the benefits in terms of cheap produce, etc etc. If anything California should be billing Vermont or Maine for the costs, heh.

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The problem is that *all* you did was a blanket amnesty. A blanket amnesty would only solve the problem if it was accompanied by measures that would stop the flow of illegal immigration -- either by legalizing it, or physically stopping it.

Your program, OTOH, sounds pretty workable in rough outline. I could get behind it.

dteowner said:

We did that legal dance about a decade ago, magerette. The lawyer did it as a "package deal", so we paid $300 (IIRC) and got living wills, ummm, dying wills, and all the various powers of attorney all in one fell swoop. Nice and neat, all legal, and didn't get soaked on the "per hour" game.

I remain very disappointed that I couldn't jam thru my wish to have my corpse thrown in a ditch somewhere. None of this boo-hooing at a viewing and expensive boxes with pretty lining and screwing up traffic on the way to a cemetary...

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Thanks for the legal tip. I so agree with you on the death industry--I just want to be cremated and ignored, but it seems you have to pay as much for that as a funeral here, including from what I've heard, a cemetery plot to bury your freakin ashes in a concrete vault. Personally, if I were going the ostentatious mourning route, I'd like a Viking funeral complete with burning boat but that would probably seriously disrupt the local bass fishermen.

*snip*
1) Let people die.

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Agreed. Again, why not? We all are going there anyway. I like the Native American attitude--when you're really so sick and debilitated that you can't enjoy your own life or contribute to the tribe--even by watching the kids or telling stories, or gnawing deerskins anymore--why not keep a little dignity and go off in the woods and get it over with?

2)... Second, set up some clinics.... I'd prefer for it to be privately run, but if you big government weenies really want it as the first step in your march to HillaryCare, I'll live with that.

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To some extent, as Rith mentioned, there are DHS options for extra low income people similar to this already, paid for by the states but at normal existing facilities. It would be great to have the options to use them and co-pay according to income and insurance and so forth as you suggest. Unfortunately, they're only as good as the local talent and efficiency allow. My redneck relatives downstate are using them now that the husband and principle wage-earner's been laid off from the door-making factory, and they provide basic care for them all, but at a very low level of competence, mostly due to the region(They usually go to Fort Smith, AR). Sometimes they can't even find a doctor who knows what tests to give, let alone is able to diagnose problems correctly. (They've almost killed him twice with medication conflicts, and he now has permanent seizure issues from something they gave him for his diabetes.)

There are so many problems facing the health services industry that it's crumbling in most areas. If you're like bn and fortunate enough to have good employer-based insurance and excellent local care facilities, you're extremely lucky, and imo, whatever is working in instances like his should be fostered and extended as much as possible, which is why I'd like to see the health care initiative combine all the ideas that work, public and private.

My grandfather always just said "Bury me if you want, if not then let me rot." He also mentioned that the day he notices he's no longer capable of taking care of himself, he'll stagger off to his boat, take it out to the nearest deepish spot in the sea, loop the anchor cable around his ankle, and throw it over. "You'll know where to find me."

He didn't have to. He keeled over in front of his neighbors with a massive coronary at the age of 87 years, just after a bout of gardening. He was dead before he hit the ground, lucky old bastard.

Damn, I miss him.

Ah, that's the way I want to go, face down in the flowers. (And sometimes that's the way I already feel after a hearty gardening session. )

magerette said:

Unfortunately, they're only as good as the local talent and efficiency allow. My redneck relatives downstate are using them now that the husband and principle wage-earner's been laid off from the door-making factory, and they provide basic care for them all, but at a very low level of competence, mostly due to the region(They usually go to Fort Smith, AR). Sometimes they can't even find a doctor who knows what tests to give, let alone is able to diagnose problems correctly.

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My "clinics" probably end up tied to the hospitals they're semi-replacing, so they'd probably get staffed by the hospital physicians on some sort of rotation. That's still no guarantee of competency, but it's probably a step up.

Now, if we take this clinic concept to the next level, we can have some real fun. I'd still privatize it, but let's give HillaryCare another shot in the arm. Parse it out by population and distance. It's not that hard to say that you want a doctor for every 1000 heads, within a 1 hour drive. That will force some clinics in BFE and you'll probably have to pay your doctors a little more to go there so you can cover Cement, OK (that's SEE-ment, ya damn yankee!). So it goes. But I'll give you a nice carrot. If you're working at these clinics, Uncle Sam picks up your malpractice insurance. That's BIG bucks for a doctor, and will help attract better talent. As a side benefit, I bet that lights a big fire under tort reform, which we desperately need.

dteowner said:

If you're working at these clinics, Uncle Sam picks up your malpractice insurance. That's BIG bucks for a doctor, and will help attract better talent. As a side benefit, I bet that lights a big fire under tort reform, which we desperately need.

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Now *that's* a brilliant idea. Which means it'll never happen, of course.

Prime Junta said:

There's a reason this won't ever fly: it goes contrary to the fundamental medical ethics that get drilled into med students from day one (and usually predate med school for most of 'em anyway).

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I disagree. We turn people away all the time for various levels of health care. Hell, the whole reason for the 'urgent care' explosion is that 'urgent care' facilities CAN turn people away, while ER's legally cannot.

You are referring to ER care -- which is only free if you're indigent. If you're not, they will bill you, and go after your car/house/whatever, if you don't pony up. Right?

.....

nd have no repossessable property. However, if you're, say, unemployed and therefore have no income, but still own your house, they will take your house first.

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And about 99% of those bills never get collected. Most of those people have no tangible assets, and if they do, it is their house and in most states, there are protections against seizing houses for anything other than mortgage default.

Prime Junta said:

What about a parallel public/private system? The gov't provides public health care one way or the other, either by being the provider itself, or through an insurance system like in the Netherlands, as described in the other NYT article, or by compensating health care costs against a standard baseline, and if you want something extra on top of the "baseline" level, you pay for it out of your pocket (direct or via supplementary insurance). How would that lower the standard of care available to you?

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I'm fine with that so long as the efficiencies realized in it keep my costs at least the same, if not reduce them. What concerns me is that I doubt, at least in the immediacy, that that will be the case. In all likelihood, and I've spelled out the numbers of how this could/would happen in some of our other threads, for people like me, I'll have to pay significantly more than I already do to get the same care.

blatantninja said:

And about 99% of those bills never get collected. Most of those people have no tangible assets, and if they do, it is their house and in most states, there are protections against seizing houses for anything other than mortgage default.

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Medical expenses are one of the leading causes of mortgage default, so that's a bit of circular reasoning.

dteowner said:

That's BIG bucks for a doctor, and will help attract better talent. As a side benefit, I bet that lights a big fire under tort reform, which we desperately need.

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The problem with tort reform is that it's designed by lawyers. They passed tort reform in Texas when I was there. In essence it did the following:

1) Lowered malpractice premiums for doctors in the state (Good as it reduces costs)
2) Attracted an influx of doctors to the state (on the face good, but a large concentration of them were docs that had been repeatedly sued in other states, so mixed bag, leaning toward bad)
3) Lowered payouts of malpractice suits, but did it in a blanket way that ultimately left a lot of patients out to dry. (Bad).

I'm no fan of tort lawyers, and while our reform was aimed at reducing punitive damages, it had far greater effects than that (Such as making anything but the really high end cases not worth a lawyer's time to take the case, thus giving docs a free pass in the minor cases.

I don't think tort reform is really the way to handle the problem. The problem is much more a central problem of the legal profession and must be dealt with that at that level.

magerette said:

Medical expenses are one of the leading causes of mortgage default, so that's a bit of circular reasoning.

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That's true, but the house still isn't being seized by the hospital. The hospital isn't getting any more money to pay for the treatment that generated the bill.

dteowner said:

If you're working at these clinics, Uncle Sam picks up your malpractice insurance. That's BIG bucks for a doctor, and will help attract better talent. As a side benefit, I bet that lights a big fire under tort reform, which we desperately need.

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Not a bad idea, but you'd have to have some form of qualification to screen doctors before they get hired and annually, otherwise you'll just attract the doctors that get sued the most.

blatantninja said:

That's true, but the house still isn't being seized by the hospital. The hospital isn't getting any more money to pay for the treatment that generated the bill.

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I doubt it makes much difference to the person losing the house, and before that person defaults on their mortgage, the money has indeed gone to paying hospitals and doctors instead of the mortgage--but I'm sure from your business-oriented point of view, you're perfectly correct.