The Treatment of Illegals in the U.S. Health Care - Term Paper Example

Illegal Immigration: The Ethical Dilemma for Health Care Professionals Abstract It is obvious by now that economic, cultural, technological, social, and psychological processes affect modern health care, particularly how that health care is provided and to whom. An important social element in this conversation must be the current hot-topic of illegal immigration and the health community’s ethical responsibility to provide health care to members of a sub-community that technically does not exist under U.S. law, yet drains its health resources. The treatment of illegals in the U.S. health care system must include a realistic yet ethical component consistent with our human values. California: Cost v Ethics Vallejo California is an interesting case study of one community effort seeking to supply primary care to the poor. It’s proponents say the clinic is saving local emergency rooms thousands by providing non-emergency care to uninsured patients (many illegals) at low cost or free of charge. Many illegals, without proof of income, are receiving the services free of charge. Many residents want the clinic’s county funding cut to reflect its treatment of illegals who they believe should not be receiving health care at the expense of taxpayers. The problem is twofold and highlights two major issues concerning health care today: “the un-insured and balooning costs” (Jordon, 2009, para. 4).The tip of a controversial iceberg, if health-care reform goes through the way The U.S. House bill is written, no such clinic, in California or otherwise, will receive any federal funding if it continues to treat illegal immigrants. And from opinions so far, local voters may not approve public funds to do the job. It is a health care conundrum that threatens to drive illegals back to expensive emergency rooms, and/or in denying them clinic treatment, running the risk of them not receiving treatment for diseases they may spread to the entire community. The Pew Hispanic Center reports that half of the twelve million illegal immigrants in the U.S. do not have health insurance and go to emergency rooms where they are bound by a 1986 law to be treated. Emergency-room visits, where treatment costs are much higher than in clinics,” jumped 32% nationally between 1996 and 2006, the latest data available” (Jordon, 2009, para. 5). More than an ethical question for Sutter Solano Medical Center Chief Executive Terry Glubka, Gluba, in pushing for the clinic, was trying to reduce costs at the hospital where the poorer population [including many illegals] were coming to get treated for everything from bug bites to severe injuries. By opening the center she hoped to serve people who were using the emergency room inappropriately at a reported cost of $12 million in “charity services” (Jordon, 2009, para. 7) She saved the hospital $4 million in a year. "They were getting the most-expensive care for what should be treated in a primary-care facility” (Jordon quoting Gluba, 2009, para. 8). As in emergency rooms the clinic does not inquire into immigration status and does not ask for documents. At the beginning many thought it a good idea. Sutter and another nearby hospital, Kaiser Permanente Medical Center, each committed $100,000 annually over three years. Solano County's board of supervisors voted 5-0 in 2008 to contribute $250,000. (Jordon, 2009, para. 6) Since illegal immigration and the “rights” of illegals has become a hot button issue, attitudes have changed. Threats of reduced federal funding and local awareness and animosity have turned a critical eye toward funding health care for people who are not even supposed to be here in the first place. “llegal immigrants can get emergency care through Medicaid, the federal-state program for the poor and people with disabilities. But they can't get non-emergency care unless they pay” (Wolf, 2008, para. 9). Some who formerly supported the clinic are now focusing more on the immigration flap and many want the clinic to stop serving illegals altogether, threatening to withdraw funding. A Solano County supervisor--an original supporter of the clinic--wants a fail-safe documentation system in place and in use by health workers to prevent taxpayer money from going to illegal immigrants in the form of free health care. (Jordan, 2009) Others approaching the question from a pragmatic public health viewpoint say preventing illegals from using the facility will cause a health crisis in the community including the spread of disease among illegal populations and outward for lack of treatment. (Jordon, 2009). It is interesting here that none of the arguments presented reflect an ethical viewpoint from any of the principals regarding how moral and ethical health issues come into play—not an usual occurrence these days when health care and health care reform are under contentious discussion. While the latter position of treating everyone, regardless, in the interests of public health safety reflects a degree of ethical thought, it does not address the issue of the human right of people to be treated when sick and how that stance plays out in the real world of dollar and cents. The Issue and the Dilemma For Solano County health services the issue is clear. The County has quite a number of low-income people who need health services. These people, who pay on a sliding scale or who, as citizens, are legitimately covered by Medicaid or other programs must and should have access to the care provided at the clinic. It is also clear that these people, without access to insurance and primary care doctors, will seek help from emergency rooms required by law to treat them at exorbitant cost if they do not have access to the clinic. That being the case, the county’s efforts to fund and run a clinic for lower income, uninsured people is both logical and wise. It may, after the health reform issue is finally resolved, end up being the norm in the U.S. for health care access for such populations in future. Enter the illegal population into the discussion and the issue becomes unmanageably complex, bringing to the table political, legal and cultural issues having little to do with health ethics and more to do with politics and hard economic reality. The Outcome: Fair, Ethical or Merely a BandAid In December of 2009 the issue was somewhat resolved and the program survived—temporarily. After a civil grand jury investigation by the [County] Board of Supervisors was conducted and the Board voted to retain the program for illegals while the Congress debates reform. As both an economic and ethical solution, it is an example of a community finding a way, if temporary, to address the reality that undocumented immigrants will probably not be covered by health care reforms. Communities and health officials as ethical bodies and people may have to come up with another way of dealing with the problem. “The Community” by definition, is a Board that speaks for it, not the community itself. With the fires against illegal immigration being fanned daily, it is likely that Vallejo’s decision to maintain the clinic may, in future, come under fire again. When it does, it will be a confrontation between hard economic facts, the law, and ethics. For now the Partnership survives. Whether it will be able to continue to provide the services to illegals may become more a matter of law than ethics. The clinic still sees anyone, on a sliding payment scale, including illegals, who are mostly seen gratis. The philosophy: people if sick or injured need to be cared for in the interests of the entire community. However, many, too many to be discounted think otherwise: As the debate over the residency status of the nation's estimated 12 million illegal immigrants boils, another battle is simmering over what — if any — benefits they deserve while they're here. Some of the most heated arguments on the issue focus on health care. So far, immigrants are losing. (Wolf, 2008, para. 4). Legislatures throughout the U.S. are slowly and almost silently limiting access to benefits to illegals. Health care is one of them. A recent move to include the legal children of immigrants in the heralded State Children's Health Insurance Program (CHIP) was stalled in the U.S. Senate until it was assured that access to the program would not include illegal immigrants. (Wolf, 2008) A Personal Perspective: The Rationale in Handling the Problem Let us pretend for discussion purposes that threats to cut private, county and federal spending come to fruition. What then are the ethical responsibilities of the health community to provide services to those whom the law [government] determines are not deserving. Of course the pure moral and ethical stance would be that no one is undeserving, but simply ineligible. Also, does not the administrator have personal and moral responsibilities to the great number of uninsured people of lower economic status who are not illegal but need services to keep the clinic working? To shutter the clinic would surely be unethical in that respect, punishing, as it were, those who most need help because a legal glitch involving some of the clinic’s clients make it impossible to provide the service. Should the clinic then be sacrificed in the interests of continuing to provide services to patients who are not contributing economically to support those services? Should it be saved at the expense of failing to provide health care for illegals? I would say no, and agree with Solano County Health Director, Patrick Duterte. “My position is that to have a healthy community we can't have a subset of people who don't have access to health care... It's bad public-health policy"(Jordan, 2009, para. 22). Given that other alternative must come into play, including a way of funding at least primary health care for illegals, with the caveat that negotiations with their countries should be worked out for relocation for treatment for serious ongoing disease or injury. (quoe about guy sent back recently) These are complex questions that go well beyond the narrow confines of health ethics and beyond to overall moral and ethical positions. An administrator charged with providing care to the uninsured should not be placed in a position of choosing patients, but in this case they are. Worse, they are placed in the position of having to tell a large segment of the population [including illegals] that they can not receive health care unless they pay for it. As draconian as this sounds, it may hold the key to solving the problem and to continuing to provide health care for such a clinic’s clients. Health care coverage in most western nations, excluding the U.S., is mandatory. In the end a system that requires some sort of payment for treatment may be the ultimate answer, even for those with low incomes. It should not be the job of the clinic to enforce immigration laws, but it is its job to provide care and also to keep it financially solvent and the public [taxpayers] solidly behind its work. Until the government sorts out the legal aspects of illegal immigration and the rights of illegals under law, health care must be provided for the reasons given but obviously not at the expense of the taxpayer. Basic required payment, in the end, may turn out to be both the most reasonable and ethical path. Illegals, after all, have access to health care in their own countries. What is provided here must be paid for, somehow, either by them or by their governments, another solution rarely discussed and I doubt, ever negotiated. In short, pay the health bills for your people who are here illegally. This position satisfies the health community's ethical responsibility to treat people and its financial responsibility to keep costs in check for taxpaying citizens. Conclusion As a future leader in the health care community decisions such as the one that must be made in the interests of keeping the Sutter Solano Medical Center Clinic afloat may arise more often than one might anticipate. To shirk that responsibility under the excuse that nothing can be done because the root of the problem involves the law is no excuse. As a leader one’s reputation can not be and either or situation. One must see to the financial aspects of health care as well as the ethical demand that people receive care when they need it. In this respect a “greater good” mentality is not merely ethical but also protects the entire community. As such, it is the responsibility “of the responsible” to see to it as best they can. In this instance that service must be provided not on the backs of taxpayers waiting patiently for the government to initiate reform that might help the situation stabilize on both counts. It is important, therefore, that health administrators work with all parties and be a strong advocate for all sides. That the costs of providing the service be shared, and not completely on the back of taxpayers seems a reasonable and ethical solution. Given the current ambiguities in the laws on illegal immigration, part of the ethical solution to this problem must be to see to it that no taxpayer funds are used to fund the portion of clinic that services this community. From my view the clinic might institute a basic realistic charge for all users in line with the western European tradition that everyone is expected to have health coverage. If things continue as they are Vliet’s argument regarding a similar situation in Arizona makes sense. “Arizona’s massive deficits [California is in the same situation], greatly increased by healthcare services for illegals, is the canary in the mine, warning of a potential explosion that may collapse the system for all” (Vliet, 2010, para. 18). This is not an ethical or practical way to go. It behooves health administrators to be more pro-active in the fight for reform that makes sense—one that does not leave a person without basic care, nor those funding our health system broken and bankrupt. References Jordan, M. (2009). Illegal immigration enters the health-care debate: In California, funding is at stake for a clinic that treats patients no matter their status; An issue 'No one wants to touch' (2009). Wall Street Journal, August 15, 2009. Retrieved July 7, 2010 from: http://online.wsj.com/article/SB125027261061432585.html Vliet, E.L. (2010) Illegal immigration healthcare costs affect you!. The Cypress Times, July 6, 2010. Retrieved July 7, 2010 from: http://www.thecypresstimes.com/article/News/Opinion_Editorial/ILLEGAL_IM MIGRATION_HEALTHCARE_COSTS_AFFECT_YOU/30621 Wolf, R. (2009) Rising health care costs put focus on illegal immigrants. USA Today, January 22, 2008. Retrieved July 7, 2010 from: http://www.usatoday.com/news/washington/2008-01-21-immigrant- healthcare_N.htm Read More