Shouldering the Burden- Immigrants and Health Care Reform

Today's Miami Herald reports on the case of 37 year old Luis Jimenez, an illegal immigrant whose serious brain injury had cost Martin Memorial Medical Center over $1.5 million…until the hospital decided to solve it's problem by secretly shipping Mr. Jimenez back to Guatemala.

My blog today isn't intended to look into the indisputably sleazy actions of Martin Memorial, which unilaterally decided to send a mentally incapacitated man out of the U.S.  The Herald said that Martin Memorial summarily chartered a plane to send him home "without telling his relatives in the
U.S. or Guatemala – even as his legal guardian frantically sought to
stop the move."  The hospital feebly responds that Mr. Jimenez, despite his incapacitation,  "wanted to go home".

Nor is today's blog intended in any way to defend the legitimacy of situations such the Jimenez tragedy, which unjustly burdened a private hospital with the multimillion dollar health care bill of a person illegally in the United States.

Today's blog is about illustrating the dramatic dysfunctions plaguing the U.S. health care system and why reform is not only needed but desperately needed.  More from the Herald:

"Hospitals
are already struggling under the staggering costs of treating the
nation's roughly 47 million uninsured. Illegal immigrants make up an
estimated 15 percent of this group, according to the Pew Hispanic
Center.

"I think they'll do what's required according to
physician orders," she said, "but I think they will be more pro-active
and aggressive in finding a discharge plan.""

Well, that might resolve the issue for the hospitals, but what will the discharge of seriously ill patients onto the streets of America do for the rest of our society?

I remember when my second son, Danny, was born in 1991 at Baptist Hospital, right here in Miami.  I had recently started private law practice and had no health insurance, and had to wheel and deal with both the hospital and the doctors to negotiate prices I could afford.  Baptist's Obstetrics unit was a veritable resort, with private rooms for each patient and a standard of comfort far beyond any I'd seen.  But when I got a $19 bill for the small box of Kleenex's my wife had requested, I went ballistic.  It was only then when I realized that under this current system – and remember, this was 18 years ago and nothing has changed except for the worse – those of us can afford to pay a little pay a LOT…to cover those who can't or won't pay anything.

The patient liaison patiently explained the $19 Kleenex box to me, and it was pretty simple: 

1. Baptist could not refuse an emergency patient
2. When a woman is in the final stages of labor and the baby's head iss crowning (as in the top of the skull visible), that constitutes an "emergency".

And so illegal immigrants – and others without insurance – would simply sit in their cars at the Baptist Emergency room parking lot, waiting for the head to crown…presto, instant 5 Star Maternity Ward for free.  The liaison further explained that because most of these women had not had prenatal care, the incidence of complications — and the resulting increased cost in care — was significantly higher than that of the "normal" (insured or self-paying, as we were) maternity ward patients.  (I should add that I've seen cases of wealthy immigrants with serious health issues leaving their money overseas and having our Medicaid system foot their care.)

My cousin Juan was visiting this past weekend and we had one of our little debates regarding health care.  He's a Libertarian (so he says) and he argued that it is not the responsibility of government to provide health care to those whom it governs.  He and I both share strong market-economy beliefs, but on this topic I respectfully disagree.  I believe that a government which cannot take care of the fundamental medical needs of its elderly and disabled population is a government which has its priorities wrong.

For the past two decades, I have been the sole caretaker of my mother, who is now 87.  I believe that we can do better than simply continue to live with a system where failed immigration policies mean private health care has to pick up the bill.  I believe that the barrage of repetitive EKGs and other exams my mother gets almost monthly are nothing but efforts by the existing medical system to milk Medicare dry.  I believe that the FBI has better things to do than deploy hundreds of agents to thwart Medicare and Medicaid fraud in Miami.

Look, I don't profess to have all or even any of the answers, but I know one thing: the system is broken and we need the federal government to fix it by looking at it wholistically and understanding the basic interrelationships between immigration policy, foreign policy, and health care policy.