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Friday, October 2, 2009

Solving The Immigration Health Care Issue

The United States Congress and the President are now grappling with the health care issue for illegal or undocumented immigrants. There are currently, two prevailing arguments in this debate.

The first argument states that if immigrants need or desire health care, while they are in the United States, they should arrange for this care, independent of the U.S. Tax Dollar. Proponents of this argument wish to exclude illegal immigrants from coverage, citing a foreseeable barrage of people flooding into the U.S, in order to obtain health care. In addition, many feel that it is unfair for the U.S. Taxpayer to bear the financial burden of illegal immigrant health care, while these people are in the process of breaking U.S. laws.

Contrarily, people on the other side of this debate contend that the U.S. should provide health coverage for these people. They believe that when a person presents themselves to a medical facility, the humane thing to do is to treat them, regardless of national origin or documentation status. They philosophically believe, that since we are all human, we must be our brothers keeper, without concern for the financial costs or social ramifications.

Personally, I can see both sides of this issue. If I am looking at this issue with a strict financial eye, excluding illegal or undocumented immigrants becomes a solid business decision. The burden on the U.S. taxpayer may become overwhelming. Individuals may realize an increase in their tax burden, while services to them are simultaneously reduced. Many Americans are suffering financial difficulty and are apprehensive about undertaking additional burdens.

I can also see the point of the second group. I imagine myself being in an emergency room, when a mother brings in her sick or injured children. It is my believe that most Americans would reach out to these people and want them treated, regardless of where they are from. It has been my experience that most Americans are incredibly generous and willing to do extraordinary things to help their fellow human beings. We only need to look at the private efforts of hundreds of U.S. formed groups across the globe, feeding poor families, providing education, providing disaster relief and volunteering time for their fellow man. The generosity of the U.S. Citizen is truly astounding.

I also believe that the immigrant health care issue is a troubling issue for countries all over the world. Also, it makes little difference if an immigrant is documented or not. If an individual needs health care and cannot afford it, both groups have the same problem.

So the question becomes: How can we best provide humane and compassionate health care services to immigrants (documented or undocumented), while simultaneously establishing an equitable way of distributing the costs to the responsible party?

The solution I envision has complexities, but it also utilizes an established infrastructure and entity for managing such a system of health care. The totality of ramifications and specifics are yet undefined, but the basis of my proposal is to utilize the United Nations to establish an International Health Care Fund (IHCF) for all of it's member countries.

Of course, like any other discourse, a premise of believe must first be acknowledged before considering the entire proposal. My premise is simple. Governments have inherent responsibilities for their citizens, even when they travel, legally or illegally, to other countries. This premise must first be accepted, because not accepting this would mean that governments can freely drive out unwanted populations from their country, in order to rid themselves of financial woes.

As an example, how would Canada view the United States, if the U.S. did not have adequate medical facilities, or adequate health coverage for it's citizens, and millions of people started to go to Canada for free government health care? Obviously, the influx of people would over burden the resources of the Canadian medical community, and catastrophe would result. Wouldn't Canada feel that the U.S. Government had a responsibility to create an environment, where basic services of it's people (whether through affordable private health care or other system), were maintained? Of course they would. And in my opinion, rightly so.

Keeping this premise in mind, why not let the United Nations establish an International Health Care Fund? This way all member countries can contribute their fair share, and the IHCF can disburse payments as an insurer?

Let's look at how the system currently works in the United States. An immigrant is in need of health care. The immigrant cannot afford to go to a doctor, nor can they afford health insurance. The only alternative (other than suffering) is to go to an emergency room or some form of medical clinic. In most states, the hospital is obligated by law, to treat anyone who walks in the door. The hospital treats them and sends them on their way. Now, here is the tough part. Who is paying for this? Well, it depends on the state. Many states will reimburse the medical facility through Medicaid or AHCCESS programs. Some medical facilities will write these expenses off, and in turn, raise their fees to all other paying patients. Either way, it puts the burden on individuals and states, who are clearly not the responsible party.

Why not treat the immigrant, and then have the medical facility bill the International Health Care Fund, just as they would domestic insurance companies? This way, the responsible party will be paying for the treatment, an overwhelming burden will be lifted from individuals and states, and immigrants receive quality health care.

How much does each country pay into the fund? The contribution amount will be determined over time. The amount that each country pays will be directly proportional to the amount of claims being paid out by the fund. So, using our previous example, if Canadian health facilities submit an amount equal to 30% of all claims submitted to the fund, for U.S. Immigrant health services, then the United States will pay into the fund according to this proportion. Of course this will be calculated over time, and across all member states.

Why have the United Nations manage this? Well, their are various reasons. Primarily, because the membership infrastructure is already in place. In addition, if a single country refuses or is unable to meet it's obligations, consequences can be more readily applied.

What type of consequences? There are to many to debate in this writing, but one variation can be to allow other individual countries (or representative companies) to extract actual resources from a non-paying country. Here is an example. Let's say Canada submits claims for treating U.S. Citizens in the amount of $5 milllion. Let's then say that the U.S. is unable to pay this amount to the fund , and is in default. By agreement, either the IHCF, or an entity representing Canada, can seize U.S. Resources. Government owned resources such as oil, gas, forests, parks etc... up to the amount owed. This will clearly provide incentive for countries to pay their portion of the fund.

In addition, establishing an equitable system such as this, will also cause many countries to rethink how and why many of their citizens are leaving. Governments across the globe will have new incentive to create environments conducive to the well being of their citizens.

Clearly, this is a simplified version of the potential of such an international organization. However, I do believe that establishing such an institution, will allow us to be humane and compassionate human beings, but also bring an equitable resolution and responsible governance to a serious world issue.