Illegals Push Native-Born Little Old Ladies and Children Out of Their Hospital Beds

Ronald Bailey | March 7, 2007

That's what some nativists would have you believe. Similar, but less extreme claims, are made by Rep. Tom Tancredo (R-Colorado) who asserts :

While illegal immigration isn’t generally the first thing Americans think of when they think about health care, it has a significant impact on the cost, availability and quality of health care available to Americans.

Significant? A short item in the March/April issue of Foreign Policy (not available online) based on a Rand Corporation study takes look at the claim. The FP notes that U.S.-born residents make up 86.9 percent of the population; legal immigrants 9.9 percent and illegals 3.2 percent. Their respective shares of healthcare spending are 91.5 percent, 7 percent and 1.5 percent.

Based on that data, the FP concludes: "You can no longer argue that illegal immigrants are an excessive burden on U.S. healthcare."

Comments

B|3.7.07 @ 12:34PM|#

Ron, I really hate that you're putting me in a position to defend a fuckwad like Tancredo, but...

Did the Rand study only look at the US population as a whole? That seems like pretty fundamentally flawed methodolgy. Wouldn't looking at hospitals in some specific cities, such as (I don't know) Los Angeles, San Diego, Tucson, Phoenix, El Paso, San Antonio be more instructive? The nationwide impact may be small, but it is almost certainly higher in cities with high imigrant populations.

The plural of anecdote certainly isn't data, but I used to live and work in Tucson, and the only level 1 trauma ER (in the same hospital where I worked) in town was (and is) *definitely* bogged down by sheer numbers of uninsurred people who were using it as their primary care. I'm not saying they're all illegal, but a lot of them most likely are. And the hospital is often stuck with the bill.

None of this is intended to be arguement in favor of Tancredo's views on immigration, just that the study you cite (at least as quoted) doesn't seem make the point that you or Foreign Policy want it to.

|3.7.07 @ 12:39PM|#

Well, assuming that the burden is borne disproportionately by ER's in the Southwest, it would still be cheaper just to get the federal government to pay for that than building a stupid fence and deporting the twelve million or so illegal immigrants in this country (twice the jail population, I believe).

jiddy|3.7.07 @ 12:44PM|#

Isn't every public dollar spent on healthcare for illegal immigrants excessive? They should be using the health care system of the country they are supposed to be in, not the one they broke into by subterfuge.

|3.7.07 @ 12:46PM|#

You can no longer argue that illegal immigrants are an excessive burden on U.S. healthcare

Maybe not, but if 3.2% of the population is paying 1.5% of the bill, you could say they consume a disproportionate share -- twice what they pay for.

KoWT|3.7.07 @ 12:47PM|#

factor in the huge amounts of money collected from illegals in the form of Social Security and Medicare taxes and illegal immigrant laborers are an obvious net gain for the feds

|3.7.07 @ 12:49PM|#

I am so so so tired of hearing about emergency rooms' being the primary care facility for the uninsured.

This problem has a trivial trivial solution. When someone comes to the emergency room, ask him in whatever language is appropriate, "Is this an emergency?" If it is not, send him next door to the non-emergency room.

What, no non-emergency room? Are you health care providers idiots??? Or do you just get your jollies charging people who come in with a cough for the cardiac surgeons you have on call?

Note that this "urgent care center, what is an urgent care center?" behavior results in massively overstated charges compared to the actual costs of treatment.

|3.7.07 @ 12:51PM|#

B: Here's a link to the press release for the Rand study. And here's another to a Los Angeles Times story about the Rand study. A quote from the LA Times:

"There are taxpayer implications to illegal immigration, but healthcare is not one of them," said Jim Smith, a senior economist with Rand and author of the study. "Why are we talking about healthcare when that's only $1 billion a year?"

B|3.7.07 @ 12:51PM|#

FFF--that, or perhaps making it easier for the gainfully employed to do so above-board and maybe get some health insurrance?

B|3.7.07 @ 12:52PM|#

Ron--thanks!

|3.7.07 @ 12:52PM|#

only one study? surely you jest...(and don't call me Shirely)

|3.7.07 @ 12:54PM|#

B, there are lots better solutions, but I think as a stop gap, that one works best. It'd be easier since the locals wouldn't be going apeshit over illegals.

|3.7.07 @ 12:54PM|#

jiddy: I hestitate to suggest it, but one solution to the "illegal" immigrant problem is the same as for the "illegal" drug problem. Just get rid of the laws that make either "illegal" and presto! no more need for "subterfuge."

|3.7.07 @ 12:54PM|#

since they wouldn't have local institutions strained under the burden.

works politically the best, I mean.

|3.7.07 @ 12:55PM|#

"Well, assuming that the burden is borne disproportionately by ER's in the Southwest, it would still be cheaper just to get the federal government to pay for that than building a stupid fence and deporting the twelve million or so illegal immigrants in this country"

You're assuming that health care is the only public expense from illegal immigration. There are also other non-monetary costs, for example, the utter trashing of once-pristine desert in southern Arizona, which must be seen to be believed.

|3.7.07 @ 12:57PM|#

The trashing of the desert wouldn't have occurred had it not been for the ineffective interdiction policies of the federal government. People would still crossover in more populated areas, which is safer too.

B|3.7.07 @ 1:03PM|#

OK, so it looks like tax dollars spent (which is what the Rand study looked at) and the imact on availability and quality of care (which was what I was getting at) are really seperate issues, and probably shouldn't be conflated. Point taken.

Also from the LA Times article:

"From the studies that we have done, [the Rand study] certainly is a low-ball estimate " said Jack Martin of the federation. "But there are issues other than cost…. In the emergency rooms, it has to do with very finite resources and the fact that those medical facilities end up at times being severely overburdened so that the quality of attention that they can give to U.S. citizens and legal permanent residents is degraded."

Personally, I would cut "to U.S. citizens and legal permanent residents" out of the above statement, because in truth this degrades the quality of care for anyone seeking it.

MikeP--I agree in principle, but I believe ERs are legally bound to treat all comers. Which would be another avenue for reform that doesn't involve building walls in the middle of the desert.

|3.7.07 @ 1:04PM|#

"Isn't every public dollar spent on healthcare for illegal immigrants excessive? They should be using the health care system of the country they are supposed to be in, not the one they broke into by subterfuge."

You can make a moral case that they should - just as you can make a moral case that the taxes they pay to our local, state, and federal governments (a much larger dollar figure) SHOULD be going to foreign governments.

But this study isn't about moral issues, but practical, concrete, financial issues, and the financial analysis shows that, all things considered, they do not impose a financial burder on this country.

|3.7.07 @ 1:04PM|#

Just get rid of the laws that make either "illegal" and presto! no more need for "subterfuge."

But Ron, they took our jobs!

D.A. Ridgely|3.7.07 @ 1:09PM|#

While illegal immigration isn't generally the first thing Americans think of when they think about health care, it has a significant impact on the cost, availability and quality of health care available to Americans.

I'm sure that's true. Imagine how much more expensive hospitals and clinics would be if they had to hire legal workers to do all the scut work!

The Wine Commonsewer|3.7.07 @ 1:12PM|#

You can no longer argue that illegal immigrants are an excessive burden on U.S. healthcare.

I guess that the term excessive is pretty subjective. I would argue that any burden is too much, but we are still talking about a billion dollars for taxpayer funded health care for non-citizens. That's a problem.

Too often, we open borders advocates refuse to acknowledge that there are any problems associated with immigration. So long as we stick with that line we'll make zero progress with the rest of the populace.

|3.7.07 @ 1:13PM|#

True dat, DAR.

If there's a Paperwork-Deprived America-Joiner near some old lady's hospital bed, he's a hell of lot more likely to be emptying her bedpan than changing her sheets.

|3.7.07 @ 1:14PM|#

er, "...or changing her sheets."

On the bedpan/laundry issue, I'm still collecting data.

|3.7.07 @ 1:16PM|#

"While illegal immigration isn't generally the first thing Americans think of when they think about health care, it has a significant impact on the cost, availability and quality of health care available to Americans."

I think he may be right here, just not in the way he intended.

A lot of elderly people on fixed incomes have to choose between the high costs of home health care and going into a home. When thinking of health care, most Americans probably don't think about the costs of having someone to mow the lawn, do some shopping, clean the house and, indeed, just keep an eye on grandma or grandpa. But by providing those services at lower costs, I suspect illegal immigrants have some impact on keeping down health care costs for the rest of us.

|3.7.07 @ 1:16PM|#

I agree in principle, but I believe ERs are legally bound to treat all comers.

I am not talking about the legal obligation for ERs to treat all comers. I am talking about ERs separating actual emergency cases from nonemergency cases.

There are roughly two possibilities:

1. The emergency room is underutilized. In this case, the finances of the ER are improved by handling nonemergencies. And if they cost and bill them as nonemergencies, they might actually stand a chance of collecting some payment.

2. The emergency room is overutilized. In this case, they should open a non-emergency room next door. No one who does not have an emergency will walk into the ER if there is a UCC next door. Again, charge what it costs, and you might collect.

An overburdened ER simply should not happen. And if you charge $250 for a visit to the UCC next door, you are much more likely to collect than if you charge $925 for a non-emergency visit to the ER when it didn't cost anything close to that to provide the service.

|3.7.07 @ 1:16PM|#

This strikes me as playing pretty loose with the statistics. In addition to the valid points that B makes on the first post, there is also this to consider; the majority of healthcare spending in this country is spent on the elderly. Ilegals tend to be young and healthy. Since illegals are as a group younger than the average, it is not really accurate to compare their aggregate health costs to the aggregate health costs of the entire popultion. I would like to see a comparision of the health costs associated with illegals versus a native group of a similiar age range. Yeah, illegals may cost less now because they are younger, but how much does health care cost for them versus natives of the same age? Further, regardless of the health costs today the majority of the illegals are going to stay in this country and get old someday and the rest of us are going to be paying the bill. Thirty years from now when the country is face with paying for the retirement and elder care of the great immigrant wave of the 00s, that statistic will look a whole lot different.

|3.7.07 @ 1:22PM|#

But John,

If Paperwork-Deprived America-Joiners actually are, in the aggregate, younger than the population as a whole, why would a normalized per-capita comparison matter?

|3.7.07 @ 1:27PM|#

In Mexico, if you give a cop $20, you can drive like Nicholas Cage in Leaving Las Vegas.

So when they come up here, some Paisanos are surprised by our Gabacho attitudes toward driving drunk.

Recently, a paperwork-deprived America-joiner killed a couple people and injured some others after he drove after drinking a cerveza or 8.

So the medical bills racked up by the US-born people that he hit fall under the 91.5%, right?

Andy|3.7.07 @ 1:33PM|#

In addition to the very good points already made about both the age distribution of illegal immigrants versus others, and the regional concentration of the immigrant population, this data is so vague as to be functionally useless. With no definition of "healthcare spending", it leaves open the possibility that these statistics include elective procedures, dental procedures, and god knows what else. And by measuring it in cost, and not time, it says essentially nothing about the initial point you were trying to make.

Choosing to pay for a brand-name drug or an additional procedure increases cost, but doesn't increase time or effort of emergency medical professionals, which is the implication you seem to be drawing with your whole discussion of stealing beds from grandma.

In short, even IF that Foreign Policy article came to the conclusion it thinks it does, which it really doesn't seem to, it doesn't speak to distribution of emergency medical services, which is the point you seem to be trying to make.

|3.7.07 @ 1:39PM|#

Gee, it's a good think Americans don't cause any fatal auto accidents.

The Wine Commonsewer|3.7.07 @ 2:04PM|#

Rand has played fast and loose with statistics in the past, I don't put any particular stock in anything they report, particularly when there are several other studies that come to different conclusions than this one.

|3.7.07 @ 2:19PM|#

The real question is - what percent of the 1.5% are the illegals paying themselves, and what percent are they asking the rest of us to pay for them? And how does this compare to legal residents?

The stats in this study don't really tell you anything about the healthcare costs of illegals...

|3.7.07 @ 2:26PM|#

Do you count a paper-deprived woman giving birth under "illegal immigrant" health care spending?

The kid would be an paper having American right? So, what 50-50?

|3.7.07 @ 2:27PM|#

It's a strange health care system where a woman from Mexico can cross the border and have a baby at the taxpayer's expense, but soldiers with their arms a legs blown off get lousey care.

As far as I am concerned illegals can use our system as much as they wish, as long as they pay for their own care.

|3.7.07 @ 2:28PM|#

"The kid would be an paper having American right?"

They call those "Paperweight babies."

|3.7.07 @ 2:30PM|#

On the topic of immigrants, legal and other, and healthcare..

Most of the really disgusting caretaking work done where I work is done by recent immigrants. They tend to be the ones who make up most of the lowest rungs in the healthcare employment ladder. I would caution the babyboomers that they need to make sure that there is a constant stream of new immigrants coming into the country who will change their bedpans in the coming decades.

The Wine Commonsewer|3.7.07 @ 2:30PM|#

I once had a client who went back to Mexico to have each of her four kids. I asked her what the heck were you thinking? They would have been citizens.

|3.7.07 @ 2:34PM|#

Doug,

The kid would be just as American as you. Thus it is his/her system.

Ron Hardin|3.7.07 @ 2:56PM|#

You'd think ``native born'' would be a pleonasm, from the etymology.

|3.7.07 @ 3:29PM|#

LONE WHACKER!!!!!!
WHERE ARE YOU????!!!!!!!

I am troubled by his absence.
So, anyway, I was talking to my buddies in the cabal, you know the one to make everyone a world citizen under the control of the Mexican gov't, about this road we're building that goes right through your front yard, and this guy, Juan - he's a hoot! you'd love him, muy wacko! - says to me that he doesn't think we should go with the tracking chips under the skin. Can you believe that shit? He thinks biometrics is coming along fast enough that we can use that to track you. ¡Que loco!

|3.7.07 @ 3:44PM|#

Rand claims that only $1 billion is spent nationwide on illegal immigrants.

On the other hand, California alone spends $30 billion a year on "Health and Human Services", mostly health care.

Can anyone here reconcile those two numbers?

http://www.ebudget.ca.gov/BudgetSummary/GRE/1249559.html

|3.7.07 @ 3:56PM|#

"Based on that data, the FP concludes: "You can no longer argue that illegal immigrants are an excessive burden on U.S. healthcare."
In September 2005, I went into Kaiser Permenate hospital as one who is covered by kaiser Permenate health plan. It took me 32 hours to get a room. AND I AM A MEMBER.
I asked why, the nurse responded, "when the close 8 emergency rooms in the last year, things get backed up." This is in Los Angeles.
Anyone who thinks illegal immigrants aren't a burden is a moron. Real shit for brains.

|3.7.07 @ 4:12PM|#

The consultants who told Kaiser to consolidate their hospital system were illegals?

I knew it!

|3.7.07 @ 4:13PM|#

I am not talking about the legal obligation for ERs to treat all comers. I am talking about ERs separating actual emergency cases from nonemergency cases.

Which you can't do without giving everyone an exam.

And once you have given them an exam, you have established a treatment relationship with them subjecting you to claims of abandonment if they have anything wrong with them and you say, "sorry, no emergency, hit the bricks."

The emergency room is underutilized. In this case, the finances of the ER are improved by handling nonemergencies. And if they cost and bill them as nonemergencies, they might actually stand a chance of collecting some payment.

Right. Good one. If the patient is uninsured (as most illegals are), then the odds that the hospital will ever see a dime are small.

2. The emergency room is overutilized. In this case, they should open a non-emergency room next door. No one who does not have an emergency will walk into the ER if there is a UCC next door. Again, charge what it costs, and you might collect.

They'll use the ER if the clinic isn't open 24/7. They'll also use the ER because they think they'll get seen faster, will get better care, because they don't know/don't care ifg they have an emergency, etc.

An overburdened ER simply should not happen. And if you charge $250 for a visit to the UCC next door, you are much more likely to collect than if you charge $925 for a non-emergency visit to the ER when it didn't cost anything close to that to provide the service.

You assume that the people who use ERs as primary care clinics give a crap about the bill. They don't because they know they will never pay it.

Trust me, MikeP, your plan has been tried. It didn't put a dent in the "frequent fliers."

|3.7.07 @ 4:23PM|#

From 3 quarks daily...

"In Sign and Sight, more in the multiculturalism (ostensibly) contra liberalism debate started Pascal Bruckner's salvo against Ian Buruma and Timothy Garton Ash. This week, a thoughtful entry by Jesco Delorme:

To put it as clearly as possible: All the participants in the Perlentaucher debate so far explicitly affirm a belief in certain universal values; not one of them takes a position of genuine cultural relativism. It is unfounded, to put it mildly, to accuse Ian Buruma, Timothy Garton Ash and Stuart Sim of doing so. Why then, Messrs. Bruckner, Cliteur and Gustafsson, Madam Kelek and Madam Ackermann, do you level that accusation regardless?

I believe the answer is clear: you commit the error of assuming that the multiculturalist position necessarily implies an attitude of cultural relativism, or is subsumed under it.

Observe the thinking of one of the most prominent advocates of multiculturalism: Canada's Will Kymlicka. He includes under this heading all approaches which maintain that there are certain claims made by ethnic / cultural groups which are in keeping with the liberal principles of freedom and equality, and which justify granting certain special rights to minorities. Thus multiculturalism - in contrast to communitarianism - does not stand in opposition to liberalism; rather, a liberal order is a condition of multiculturalism's very existence. So Kymlicka terms his position "liberal culturalism." The multiculturalist calls for certain group rights as complementary to a liberal order. But the liberal order claims universal - not relative - validity. Hence the multiculturalist advocates a monistic or pluralistic world view, not one of cultural relativism!

The real question is: "On the basis of what criteria may the claims which supplement liberalism be differentiated from those which undermine it?" Ms. Ackermann and Ms. Kelek may (or may not) be right when they oppose removing private funds from banks, setting aside beaches for Muslim women, founding Muslim hospitals or the wearing of headscarves as concessions to religious feelings. But they must specify their criteria and their reasons. What, for example, differentiates a segregated stretch of beach where Muslim women may bathe unobserved by men's eyes, from a local sauna which is set aside for the same purpose on certain days of the week? To what extent does one constitute a danger to our political system, while the other does not?

In order to answer that question we should first agree on which values are essential to the liberal model of society. Only then will we be able to examine whether certain individual or collective actions threaten that model."

|3.7.07 @ 4:45PM|#

That is random.

|3.7.07 @ 4:51PM|#

"sorry, no emergency, hit the bricks."

When I go to a regular doctor's visit, I don't get an examination by an ER doctor to make sure I don't have an emergency. When I go to the urgent care clinic, I don't get an examination by an ER doctor to make sure I don't have an emergency.

I fail to see why people can't self-select at the ER door as to whether they actually have an emergency or not. If not, they get lower cost care and get charged less. Granted, hospitals will have less to whine about because if the bill goes unpaid, it is $250 instead of $925. But there will be fewer unpaid bills and lower collection costs.

They'll also use the ER because they think they'll get seen faster, will get better care, because they don't know/don't care ifg they have an emergency, etc.

Do you have any evidence of this? I don't use ERs if there is a non-emergency alternative. No one I know uses ERs if there is a non-emergency alternative. Why would people who don't have insurance do so? Are they for some reason utterly uneducatable about cheaper alternatives whose bills they can still skip out on?

|3.7.07 @ 6:59PM|#

Anyone who thinks illegal immigrants aren't a burden is a moron. Real shit for brains.

The subtleties of the argument had evaded me, but now I'm convinced.

Meet Reason\'s buddies!|3.7.07 @ 7:23PM|#

Of course, what the CheapLaborPimps forgot to mention is that many or most of those hospitals do not ask about ImmigrationStatus. Mmmm cooked statistics, yum yum yum.

|3.7.07 @ 7:29PM|#

Heeee's baaaaack!

|3.7.07 @ 7:29PM|#

MikeP -

I don't know anyone that goes to the ER for non-emergencies either. Hell, most of the people I know will wait a weekend in pain to see their doctor instead of going to the ER (if possible), but most people I know also have some insurance and have never been to the free clinics in the city.

The free clinics aren't (typically) as good as your local doctor's office, much less have anywhere near the capabilities of a decent ER room.

Due to this, it is true that the uninsured believe the ER to be bettter overall care than the local free clinic, and they might be right.

|3.7.07 @ 8:07PM|#

SixSigma,

Again, I am not comparing the ER to the local free clinic. I am comparing the ER to the UCC next door in the same hospital. Or, alternatively, I am comparing the ER for people with emergencies to the ER for people without emergencies, as declared by those people.

Hospitals pretend that treating primary care patients in the ER is expensive. But it isn't. They simply charge as though it is by averaging the costs of ER facilities not at all used by the primary care patients across all patients seen.

The ER needs to have the capacity to handle emergencies. If the non-emergency patient didn't come in to use the ER, the scant resources he would have used would instead be idle, and rather than charging someone and maybe not getting payment, they couldn't charge anyone and they would surely not get payment.

If, on the other hand, there is no idle time in the ER and non-emergency patients are hampering care for the emergency patients, then they should open a UCC next door and non-emergency patients can go in there, get cheaper care, and still not pay their bill.

|3.7.07 @ 8:38PM|#

I realize that hospitals are under multiple non-market burdens, not least of which is that an open ER is required treat all regardless of ability to pay.

However, I question the practice of charging everyone the same rather than charging for actual ER resources requested or used. In particular, actual emergencies cost more and, as they are more likely to be insured patients, the hospital can collect more for them. Those who use the ER for claimed and indemnified non-emergencies should be charged less. And, in fact, those patients may actually pay the more reasonable bills significantly more often than they would pay the ridiculously inflated bills that usually issue from ERs.

Maybe there is some advantage to hospitals' having lots of unpaid inflated bills on the books. If there is, the reasoning escapes me.

|3.7.07 @ 9:05PM|#

We need about 45 million extra peoples working legally and paying taxes and social security to balance the losses from abortion since 1973. I say let em all come and sign em up so uncle sam can bend em over like the rest of us
This will help balance the shortfalls in govt spending. Abortion is why amnesty for illegals and an open border policy are necessary.


signed,
brotherben
assistant instigator

D.A. Ridgely|3.7.07 @ 9:17PM|#

Is it just me, or does "Kaiser Permenate" sound like an Argentine dictator?

|3.7.07 @ 9:19PM|#

I'm still trying to understand why the FP munbers are such a surprise. The percentages don't seem all that out of line. Why would one assume that illegal immigrants utilize American health care significantly out of proportion with their numbers?

|3.7.07 @ 9:50PM|#

D.A. Ridgely,

It is not just you. And since it's actually "Kaiser Permanente", he serves for life!

Solitarylunatic|3.7.07 @ 10:00PM|#

"Why would one assume that illegal immigrants utilize American health care significantly out of proportion with their numbers?"

Well, because theyre evil greasers who want to take over and establish Aztlan. There worse than joos!!! Or are they?? We need to watch them too. But what about them Ayrabbs??? AAARRRGGGHHH.

|3.8.07 @ 2:06AM|#

"Why would one assume that illegal immigrants utilize American health care significantly out of proportion with their numbers?"

If one were to assume that illegals were generally poor it would follow that their diet, working conditions and living environment would be less healthy then the those who had more resources.

|3.8.07 @ 10:44AM|#

Anyone who wants to limit the flow of illegal Mexican immigrants to the US is a BIG, BAD EEEEEEEEVIl NAZI!

|3.8.07 @ 7:12PM|#

well, L. Ron, when you can ennunciate a reason for keeping this immigration illegal that does not start with "the dirty greasers will rape our womenfolk" and end with "and steal our jobs" I for one will listen.

Until then, yes, I will believe that most anti-immigration sentiment is driven by racism.

|3.8.07 @ 9:39PM|#

Actually, money is the real complaint that I've seen over the years, having grown up mostly in California (after, as the song goes, "I was born in East LA").

Specifically, people complain about the illegals coming here to take advantage of all of our taxpayer-funded services, especially health care.

Seems to me that the real problem, then, isn't the illegals -- it's the WELFARE STATE.

An ad hoc poll indicated that, if illegals couldn't get welfare benefits, most people wouldn't worry about them.

But it is kind of amusing that the conservatives, who fought tooth and nail against the National ID schemes of the Carter Administration, now are begging for the same thing in the name of immigration reform.

|3.8.07 @ 9:52PM|#

For that matter, nobody who can't trace their heritage in America back before 1492 doesn't really have a leg to stand on when it comes to illegal immigration.

I've only known one honest immigration opponent -- he told me that he's against it just so the next batch doesn't do to us what our batch did to the Indians . . . .