Archive for category care for aliens

Tiers of U.S. Healthcare

A recent U.S. presidential-candidate debate included proposals on Medicare-for-all, care for illegal immigrants and private insurance: supposedly a three tier system. Exactly which existing tiers would be removed, which would be funded and how would the budget for care work?

Consider the layer cake of U.S. healthcare, as it exists. Start at the top where little figures of a bride and groom might stand. That is the highly-privileged care provided to members of Congress and many government employees (“Cadillac” health plans with a large percent government subsidized plus pre-tax perks). That insurance provides good care (not as good as the care in the French system, but pretty good).

The next tier is the “CEO” or “rich guy” healthcare. They have so much money they don’t need insurance. They just buy what they want at big name hospitals with private suites staffed by nicely dressed doctors in suits and young nurses with little pointed hats. The motto is “whatever you want”. CT scans of everything happen at least once a year and heart tests proceed just because “you can’t be too careful”. And, heavens, the food you like is on your diet. Rating of care: poor.

The next tier is a hodgepodge of layers or “options” offered by many insurance companies like Blue Cross, UnitedHealthcare, Aetna etc. These are mostly provided through an employer group plan. And, sometimes purchased individually at a higher cost if the person is part-time or retired before age 65. Some plans have high deductibles and high co-pays that financially make care difficult to obtain. Some closed panels of providers limit where a person can obtain care and limit the options for moving or travel. The insurance companies scrape off 15% of the icing (administrative fees). Rating of care: fair to good.

Next is the Medicare tier divided into several layers including Medicare with a supplement (fee-for-service) and Medicare Advantage (per-capita). Rating of care is good with a plus for lower cost compared to the higher layers. Unfortunately, Medicare does not negotiate drug prices according to laws supported by drug companies. Rating of care: good.

Next are decorations of socialized medicine. These include the Veterans Administration, Indian Health Service and various levels of military healthcare (Tricare). Rating of care: good.

Next is Medicaid. A State run and federally supported insurance for the poor. It is limited by budgets and willing providers. Rating of care: fair if you qualify, but many who need care don’t qualify for a variety of reasons.

Finally, the bottom layer. The layer for those with no insurance and no funds. All States require emergency rooms to provide care to “stabilize” a mental or physical illness. Anyone can obtain health care in the U.S. based on this nearly insane model where people wait until they are really sick to receive care in the most expensive setting. The bills, which none in this layer can pay, are astronomical and serve only to further bankrupt the unfortunate. Rating of care: poor with no connection to a primary care provider or mental health follow-up.

In conclusion, the recent superficial debate about healthcare seems to hinge on hot-button issues like rich insurance companies, greedy drug companies and desperate immigrants who become sick. Of course healthcare costs money — only a politician would say otherwise. The healthcare system we have or will have is exactly what we plan.

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Healthcare For Illegal Immigrants — necessary

prohibidoLouise Radnofsky of the Wall Street Journal published her story (3/24/16) about illegal immigrants with the observation they do obtain healthcare (at a low level) in the United States.   As with any good reporter she just reported the facts.  But, what is missing is WHY illegal immigrants receive medical care in the United States.  Clearly illegal immigrants are illegal and they don’t have insurance or money to pay for healthcare.  So why?

The simple answer is because healthcare providers on the front lines believe all lives are worth saving.  And, they will refuse to kill people by withholding care just because society says they should.  If society is so stupid to hire aliens, to pay aliens, to house aliens, to feed aliens, and not have a guest worker program then the healthcare system unequivocally refuses to be “the wall” — ask any doctor who sees a 19 year old with an appendicitis — they will fix the problem and ask questions later.

Here is an actual case:  18 year old Manuel (not his real name) is brought by ambulance to the emergency room after a fall and is barely breathing.  He is placed on life support then the ER doctors ask the on-call doctors in the intensive care unit to admit him.  No questions are asked, he is admitted.

The background later became clear.  Manuel’s father was killed in Mexico by a drug cartel leaving his widow and several children.  Manuel could not find work in Mexico so he crossed the border to find work to support his mother and his siblings.

He was hired by a contractor to build bleachers for a local school football field.  When Manuel fell off the bleachers and hit his head it was the contractor who called the ambulance.  There was no money to pay the hospital bill which was over $100,000 — all the services were a loss to the hospital and doctors.  And yes, this case and many others like it are passed on to the public and insurance companies through higher rates.  That’s how our healthcare system works — like it or not.  It’s been that way for decades.

The ACA with the push for universal insurance makes this under-the-radar care more obvious.  The ACA prohibits payment for illegals.  However, as many large counties in the US have found it is less expensive to provide healthcare, especially for pregnant women, rather than emergency care.  One case of cerebral palsy due to complications of pregnancy can cost millions of dollars.

Manual’s case includes some disturbing facts:  drug abusers in the US are the reason drug cartels exist and in this case were the root cause of Manual’s need to work.  A contractor to a government entity (the county school district) hired Manual and did not provide insurance or workers compensation.

The school district took the lowest bidder for the bleachers and did not specify the workers should have workman’s compensation insurance.  The school district should be responsible for the medical bills but they could not afford the medical bills — the hospital did not try to bankrupt the school with suits.  There was talk of sending Manual back to Mexico by air ambulance, but the health care system in Mexico could not provide high level care.  Absolutely nobody wanted Manual removed from life support because he was an illegal alien — if they did, they would be an accessory to murder.

So, the bottom line, the healthcare system is not ever going to be an accessory to harming people.  Be thankful.  If your son can’t find his insurance card and goes to the ER with an appendicitis he will get care — they will not tell him to go to the parking lot and just die.

 

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