Saturday, September 3, 2011

Third World Health Care - First Class Disgrace

François is a refugee, one of 27,000 from Côte d'Ivoire living in a camp in eastern Liberia. His kidneys are failing and he needs dialysis three times per week. But he can’t receive dialysis under Liberia’s third-world health care system and if he’s lucky he’ll get emergency treatment when his health deteriorates to the point where he is at death’s door.

A typical response to this story is, “Oh, that’s terrible. The poor man is suffering, but that’s the way things are in third-world countries.”

Yet, this story is only partially true. His name is not François. The part about his being without care until he is close to death is true, but he is not a refugee in Liberia – he is an undocumented immigrant living in the United States of America.

François lives in Atlanta, Georgia, where a hospital recently turned away immigrants in need of dialysis. For everyone else, Medicare would cover the cost of the procedure, but despite the words of Emma Lazarus that are indelibly etched on the Statue of Liberty, undocumented immigrants are not eligible to participate in the program. According to a recent article in the New York Times, such patients were “advised to wait until their condition deteriorated enough to justify life-saving care in an emergency room.” Charity care is out of the question, because the hospitals are broke. So under our current system of health care, a patient with renal failure must put his life in jeopardy, wait until he is near death, and then consume precious and expensive emergency room resources instead of scheduling a nearly-routine procedure.

I suppose the plight of an undocumented immigrant needing dialysis in Atlanta is marginally better than that of a refugee in Liberia. After all, the United States ranks 37th in health care (despite being number one in per capita spending), while Liberia is 186th. But the gap is closing.

President Obama’s Affordable Care Act was a step in the right direction, but only an incremental improvement. While the elimination of pre-existing conditions as an excuse to deny coverage and the extension of dependents’ health coverage to age 26 were improvements, even those baby steps are under assault from the Republican Tea Party. Obama’s near-total capitulation to the insurance lobby virtually guarantees more obscene profits and CEO salaries while America’s health care system becomes more like that of Liberia than that of our European allies.

While the advocates for the best option, single-payer, were not even allowed to participate in the debates and negotiations, even their approach would not have been enough. What this nation needs is a Health Care Marshall Plan. After World War II, America spent billions of peace-dividend dollars rebuilding Europe. Now is the time to spend even more to rebuild America’s health care system. We not only need to make our health care payment system more efficient and less expensive with single payer, but we also need to invest in making the medical-industrial complex more efficient. We need to leverage technology to bring down costs and reduce medical accidents. We need to make medical school affordable to anyone who has the ability to become a doctor or other health professional. And we need to regain the lead in world-wide medical research and development.

All of this costs money, but it’s money we have. It’s money we are wasting on frivolous wars and their ancillary costs. We need to stop these wars – not in ten years, not in five years, but as soon as it is physically possible to bring our troops and equipment home. We need to restore the incremental tax level to that which we had during our years of prosperity. And we need to prosecute and incarcerate the criminals in the insurance and finance industries as vigorously as we prosecute minorities and others for minor crimes.

Only an America which provides quality health care to all – regardless of race, economic status, or citizenship – is the America that our immigrant ancestors would be proud of. 


  1. Although I believe a government run single payer system would destroy the essence of the finest health system on earth, I recognize that there are serious arguments in favor of it. Therefore, I am amazed that you would present such a poor example of one. Let’s summarize. A private hospital and at least one private dialysis center have been swallowing the costs of long-term treatment for a number of illegal immigrants. They have decided they can no longer afford the $2 million annual cost. They did not suddenly spring this on their patients, but have let them know for at least two years that they would eventually have to find alternative treatment. They even offered to pay for transport to their countries of origin and three months treatment there, but no sale. Meanwhile, Medicare, which normally pays for this, does not cover illegal immigrants. This is because Medicare answers to Congress, which answers to its constituents, who do not want millions of their taxpayer dollars spent on chronic care for illegal immigrants. So here is the money question. What makes you think a single payer system would be any more likely to pay for long-term care for illegal immigrants than Medicare is? It would answer to the same pressures as Medicare, and I can guarantee the vast majority of taxpayers do not want their money spent in this way. The only difference that a single payer system would make in this case would be the destruction of the charity care system that has at least gotten these patients this far.