Healthcare Lessons from Shylock
Back from a long blogging hiatus:
Editorial in last week’s Boston Globe calls out for Jews to remember and draw from their own history to protect immigrants’ access to health care:
US Representative Paul Broun of Georgia, a medical doctor, said on the House floor in July that “Obamacare,’’ as he calls it, “is going to give every single one of those illegal aliens health insurance at the cost of taxpayers.’’
Never mind that Americans already pay for illegal immigrants through emergency room and charity care, which drives up the cost of insurance for everybody. The Senate bill already written clearly defines eligible individuals only as “citizens or lawfully admitted permanent residents.’’ The House bills include an explicit section titled “No federal payment for undocumented aliens.’’What part of “legal’’ don’t the opponents understand?“Fed with the same food, hurt with the same weapons, subject to the same diseases, healed by the same means,’’ immigrants are no different from the Jews Shylock was defending in a great drama 400 years ago. The country needs to stop pretending that they don’t also bleed.
This is a problem we feel acutely in Massachusetts as the state tries valiantly to cover 30,000 LEGAL immigrants with 1/3 of the money they need, due to the funding pulled by the state legislature, removing Aliens with Special Status from eligibility for Commonwealth Care, the subsidized health care created by MA health care reform which sought to ensure universal health care for all MA residents, immigrants and citizens alike.
How many now middle-class Jewish families were once “aliens with special status?” If you prick them, do they not bleed?
What will YOU do about this? Or will it set a precedent for denying coverage to legal immigrants nationwide, as many fear?
Well put, Aliza. As a MA resident whose family has gone in and out of MassHealth requirements, this is great. And I love the Bard reference.
The American tendency to write immigrants out of everything is the mother of all ironies.
Aliza, I have to call you out on this. You are purposefully misrepresenting the issue. The quote is about ILLEGAL (http://dictionary.reference.com/) aliens receiving health care. Not immigrants with special status (unless illegal means special in liberalspeak). The quote has nothing to do with your comments afterwards.
You must really think idiots frequent this blog. I am offended.
Just so we’re all speaking the same language, here’s how the State of Massachusetts defines Aliens with Special Status:
So without going through this point-by-point, I think that covers most of whom we’re talking about when we’re talking about “illegal aliens” or “undocumented residents” or however else you might refer to them.
The people who wrote this statute have no courage. If one wishes to provide health insurance to all residents of the state – temporary or permanent, legal or otherwise – one should just say so. Why go through all this complexity if not to mislead people that “safeguards are in place”? They’re not in place. This statute means nothing, and can be summed up in one sentence:
Anyone residing in the State of Massachusetts has access to state health insurance.
The process of appealing the above statement as the law of the land would require some highly motivated citizens to hire highly motivated attorneys to identify a specific individual whose highly unique circumstances are not covered by the statute, launch a full blown investigation – obtaining subpoenas for records from DHS, Massachusetts Dept. of Health, Social Security Administration and who knows how many other government agencies – and then, having amassed a massive case, to launch a lawsuit against the State of Massachusetts that proves the State deliberately, knowingly and unlawfully enabled this specific individual to illegally access State health care resources.
And the consequences… the bureaucracy will issue a meaningless apology and continue doing what they were just sued for.
Is that really how we want our government to function? Subterfuge, deception, lies, irresponsible bureaucratic inertia? Today you’re on one side of that bureaucracy, tomorrow you’ll be on another. Think carefully.
Lets also point out that from a public health perspective, it is a HORRIBLE idea to limit access to health care based on immigration status. Infectious diseases dont limit their reach based on these criteria.
What you forgot to mention is that Massachusetts is removing coverage from legal immigrants because the state government is desperately trying to find enough money to keep the state-operated medical system from collapsing in the next 1-2 years.
The costs have ballooned well beyond what was “projected” when the Massachusetts experiment was started.
On a more general note, granting full welfare benefits to new immigrants and illegal aliens would simply motivate people from poor countries to come to America and become wards of the wealthy state. Why would that be good (or sustainable) for America?
Eric writes:
What you forgot to mention is that Massachusetts is removing coverage from legal immigrants because the state government is desperately trying to find enough money to keep the state-operated medical system from collapsing in the next 1-2 years.
Well yeah, it costs the government a lot to provide subsidies that go towards private health insurance premiums (which goes towards insurance company profits, paying people to deny claims, etc.). It would be much cheaper for the government to simply provide health insurance itself.
Meta aside (directed to those who want to see meaningful health care reform):
This illustrates why a plan that offers incremental improvement over the status quo but doesn’t offer a strong public option (such as some of the plans floating around Congress now) isn’t necessarily “better than nothing” and won’t necessarily open the door for a better plan in the future. Rather, any shortcomings of a weak health care reform plan will be pinned on health care reform in general (rather than on the weaknesses of such a plan), and will give people like Eric the opportunity to argue that reform has made things worse and we should go back to the way things were.
BTW since the Massachusetts “reform” started in 2006, the waiting time for medical care in Boston has shot up to the highest of any major city in the nation. Current average Boston waiting for a family practice appointment: 9 weeks. Average Boston waiting time across all medical specialties: 7 weeks.
Which is funny too, since “Massachusetts has the highest physician-to-population ratio of any state” in the country.
Let’s hear it for health care “justice”!
Eric, we can’t fix health care in just one state at a time, the whole system needs an overhaul. Currently it’s an externalizing machine that spends billions cherry picking individuals who need care the least and drives costs higher for itself. There’s very little Massachusetts could do to reign in the costs all by itself.
“On a more general note, granting full welfare benefits to new immigrants and illegal aliens would simply motivate people from poor countries to come to America and become wards of the wealthy state. Why would that be good (or sustainable) for America”
Uh, because that doesn’t happen in the real world. Welfare benefits are almost always tied to employment to prevent abuse. If immigrants refuse to work they shouldn’t receive benefits any more than someone who was born in the US should receive benefits.
There is no serious economist who would ever claim that immigration is a bad thing or ‘unsustainable’ for America. There’s a significant amount of research into the real-world economic implications of immigration. There is consensus that while things are of course not 100% positive, they are far more positive than negative.
Let me add some background and context to the discussion. I’m the research director of Health Care For All, a Boston-based advocacy organization.
Massachusetts health reform is not moshiach, but it has been tremendously successful in expanding coverage to the uninsured. Over 97% of state residents are covered, compared to mid-80s percents in most other states. The success in Massachusetts gives me hope that national reform can succeed.
Immigrants: The problem here is that since 1996 the federal government excludes from Medicaid reimbursement some legal immigrants – mostly people here less than 5 years, and some other categories, too. Massachusetts stepped up and covered them anyway, at full state cost. When the revenues plummeted this year, the state cut funding for this group (about 31,000 people) by 2/3. They will now be placed in a reduced benefit plan, inadequate but still getting most services covered. The answer is federal changes to include all legal immigrants in Medicaid.
Costs: The Massachusetts plan is not breaking the bank. A independent business-oriented watchdog group looked at the whole plan, and concluded that the costs are modest and within initial estimates. The state used its purchasing clout to keep increases below 5% for the subsidized plan. The budget problem in the state has been declining revenues due to the recession, not costs spiraling.
Availability: The shortage of primary care is a national problem, and it was always here. When more people get insurance, there’s more attention paid to the issue. Massachusetts is working on the problem by starting payment reform that would restructure care to focus on prevention, and pay more for primary care. But the problem is not caused by health reform, and is no reason to critique the plan.
The basics of Massachusetts health reform is sliding scale subsidies for low- and moderate-income people, requirements on employers to offer coverage, and on individuals to take coverage if it’s affordable, insurance reforms that allow everyone to get insurance, minimum requirements that insurance coverage be adequate, and an exchange that makes it easy to compare and get coverage. This plan is the template for national reform, and it’s been proven here. Lots of details could be better, but we’ve made tremendous progress for thousands of real people.
undocumented immigrants contribute tons of money of taxes, which they pay not only in sales tax but also in income tax, of which they dont receive the benefits from because they are forced to remain in the dark. we benefit from the low-wages they work for and the economical contributions they make to the government’s income (taxes). we should support full healthcare coverage for everyone living in the country!
Here here, rara. I would also add: non-citizen, “legal” workers also contribute via taxes and having social security taken off their pay, and do not receive benefits from the government.
rara said: ” we benefit from the low-wages they work for…”
Jewish ethics for the 21st century.
dear “formermuslim”,
i am not sure what you mean. seems that you think i am endorsing low-wages. i am actually doing the opposite, stating that it is a structural fact that US consumers (and especially US firms) benefit from hyper-exploitation. that is not just the case in the US itself with low-wage migrant workers, but also across the globe with sweatshop labor producing clothing and agricultural products and much more. i absolutely oppose that. and such opposition is not a Jewish ethic, but a universal one.
So why increase the exploitation by allowing more immigration from poor countries?
what makes you think that immigration is the cause of increased exploitation?
wages and the social safety net in the US have been under attack by neoliberal capitalist policies for the past decades, since at least the 70s. and as i wrote in the previous comment, exploitation is an international situation, not just inside the US. wages have been driven down across the border, by US companies by outsourcing production to “free trade zones” in Mexico and other places, where the conditions are terribly repressive.
Immigrants in the US can actually be credited with reinvigorating the labor movement, causing “labor revitalization” amongst the largest union confederations, who have always turned a blind eye to the hardest hit. so, actually immigrants are playing the role of pushing for wage increases, and have been successful in many ways. immigrant-led efforts were behind the recent vote of the los angeles city council for a living wage, to take just one example.
What the labor conditions are in other countries is meaningless as far as a worker in the US is concerned.
“wages have been driven down across the border, by US companies by outsourcing production to “free trade zones” in Mexico and other places, where the conditions are terribly repressive.”
Yes, jobs have been outsourced to other countries leaving less of them in the US. By what logic does it make sense then to import more immigrant workers to the US.
“Immigrants in the US can actually be credited with reinvigorating the labor movement, causing “labor revitalization” amongst the largest union confederations, who have always turned a blind eye to the hardest hit. so, actually immigrants are playing the role of pushing for wage increases, and have been successful in many ways.”
The law of supply and demand is magically not applicable to labor.
“immigrant-led efforts were behind the recent vote of the los angeles city council for a living wage, to take just one example.”
Beautiful. Create a problem (oversupply of low skill labor) and legislate a solution. Sounds like christianity. Create a problem (original sin) and afterwards the solution (JeSuS!).
“What the labor conditions are in other countries is meaningless as far as a worker in the US is concerned.”
In which sense?
“Yes, jobs have been outsourced to other countries leaving less of them in the US. By what logic does it make sense then to import more immigrant workers to the US.”
If you havent noticed, there is a rise in unemployment across the globe. Who is “importing immigratn workers”? People come on their own initiative in search of a better way of supporting themselves and their families.
“The law of supply and demand is magically not applicable to labor.”
What makes you think it is a law?
“Beautiful. Create a problem (oversupply of low skill labor) and legislate a solution.”
Not sure from whose perspective you are speaking. People are not naturally low-skilled, they are deskilled as workers through the labor process. Think of the industrialization in which the entire production process was split up into small, repetitive tasks, creating a homogenous class of workers, easily interchangeable with one another. They were deskilled through the particular organization of production. Plus, many people who work low-skilled jobs have skills way above where they can find work. The problem is capitalism, in which people are forced into positions in which their work produces profit for individual capitalists, and little for themselves.
Like I said, there are plenty of reasons to support migrant workers, because their struggles is our own.
undocumented immigrants contribute tons of money of taxes, which they pay not only in sales tax but also in income tax, of which they dont receive the benefits from because they are forced to remain in the dark.
Prove it. It sounds good and feels good, but how do you support this. What does tons of money mean? Percentage wise is it 1 percent, 10 percent, 40 percent.
If they are illegal are they really paying taxes? Do you know if they filled out a W-9? If they are trying to be unobtrusive do you think that they are really presenting themselves to answer questions.
How many jobs are lost because they are exploited. How many jobs for citizens disappeared because they could be exploited.
Do you think that those businesses who are exploiting them are giving their fare share of tax dollars to the government.
How many Mots came here legally versus illegally? I don’t know the answer to that question. But I can tell you that I know a lot of legal immigrants who are infuriated that they went through the process of immigrating legally and others aren’t.
It is easy to say that the US is better when everyone is educated and provided with health care. It is also easy to say that we have a broken system and it is not smart to encourage more people to come here illegally.
We need to take some time and come up with a realistic and viable plan to provide affordable care,but we can’t just be willy-nilly about it.
This is not as simple as some people would like it to be.