Should We Care for Illegal Immigrants?
- Posted by ryan on August 21st, 2009 filed in Policy/Politics
Good news: James Surowiecki is blogging again. Bad news: he’s using his blog to tell me I’m wrong about health insurance and illegal immigrants:
[N]one of the big European states that we traditionally look to as models of successful universal health care insure illegal immigrants, either. On the contrary, like the U.S., they limit illegal immigrants??? unpaid access to health care to precisely those situations Obama alluded to in his interview: emergencies and public-health risks, like infectious diseases. Given that we???re in the middle of a huge struggle just to get the U.S. close to where European countries already are in terms of the universality of insurance, it seems a bit much to ask that we should go far beyond what those countries are doing, and extend insurance to literally anyone who makes it across the border.
Even if you set the political calcuation aside, it???s not obvious to me that the case for insuring illegal immigrants is as open-and-shut as Ryan makes it out to be. Actually, he doesn???t make the case for it???he just assumes that opposing insurance for illegal immigrants is a shameful, inhuman position. (Here, by contrast, is a sustained argument [pdf] that E.U. countries should open their health-care systems to all immigrants.) The success of the welfare state in Europe and the U.S. (limited as it is) has been built, in large part, on ideas of citizenship and national solidarity. Now, maybe those are ideals that we should look to wipe away, in favor of a more transnational conception of responsibility, but it???s not obvious that you can do this and keep meaningful welfare states intact. More practically, offering insurance to anyone who comes to the U.S. would obviously create all kinds of complicated incentives for people to migrate here when they were sick, particularly since no other major industrial democracy offers insurance for illegal immigrants.
Several points. First, while there are many things worth emulating about Europe, I’m not sure that attitudes toward immigrants is one of them. Second, I said I understand the politics; I’m not surprised this is what Obama has to say, I’m just ashamed that American attitudes toward immigrants are such that that’s what he has to say. Third, it would obviously be problematic to insure illegal immigrants, in no small part because we have so many of them, and we have so many of them, because we’re unable to do the decent thing and allow people who’d like to come to the US to work and pay taxes to do so. The problem with giving health insurance to illegal immigrants isn’t so much the health care part as the fact that they’re illegal. I don’t think most immigrants would have a problem being pushed toward full citizenship; I suspect they’d embrace it. And a guest worker program, complete with its own set of health insurance rules, could be put together for those uninterested in full citizenship.
Finally, I understand the there are some good reasons to oppose a complete open door policy toward immigration. There are limits to the number of new people America can absorb in a short period of time. But given the massive net welfare gains to immigration, we should be erring on the side of letting too many in rather than too few. Frankly, I think America has a long, long, long way to go before we need to start worrying about whether we’re being a little too open to immigrants.
Just because it makes sense not to insure illegal immigrants doesn’t make a policy of not insuring immigrants a particularly moral or humane one. We should all be ashamed that this is where we find ourselves.
August 21st, 2009 at 2:45 pm
Well said. And honestly, the inherent nationalism of the welfare state is to me the most troubling thing about it. What’s the moral case for helping poor Americans, who are quite rich by global standards, rather than Africans, Vietnamese, etc.?
There isn’t one, as far as I can tell, other than “this is what’s necessary to ensure the domestic peace required for robust economic growth, which eventually benefits third-world citizens.” But I’d prefer something a little less third-order.
August 21st, 2009 at 3:02 pm
My main problem with the interview was that obama said: “we don???t want a situation in which some child, even if they???re an illegal immigrant, shows up in an emergency room with tuberculosis and nobody is giving them treatment, and then they???re going back to the playground and playing next to our kids.”
As if the fact that the child has TB is irrelevant, we just don’t want it infecting OUR kids. There is a difference between blindly insuring illegal immigrants and providing ER care for sick children, regardless of how infectious their diseases are, and where they are from. James Surowiecki did not address this difference at all, and argued against the straw man of insuring against everything for everyone, something which you did not say at all.
August 21st, 2009 at 3:31 pm
Medicine is practiced by a profession with professional ethical standards. Therefore, illegal immigrants will be treated. Only question is whether their treatment will compromise the financial stability of various hospitals, no matter how many nutcases grumble about it.
August 21st, 2009 at 6:35 pm
What???s the moral case for helping poor Americans, who are quite rich by global standards, rather than Africans, Vietnamese, etc.?
That you have a greater obligation to those near you - family, community, country - than to more distant people.
But actually, I mostly agree with your sentiment. Which is why I’m a big fan of things like the Gates Foundation and free trade, and why I tend to find complaints about the injustice of economic inequality within America unpersuasive.
August 22nd, 2009 at 11:47 am
I don’t see any credible moral or policy argument for the health care debate to be the place to hash out the immigration policy. Any covering of illegals would necessitate sorting out those with some claim on long term residency and those simply moving here to access free medical care in the scenario Surowiecki lays out.
Of course, that would require at least an implied immigration reform consensus, which, as of yet doesn’t exist. There isn’t a moral case to hold every other piece of legislation hostage until that particular consensus can be reached.
August 22nd, 2009 at 8:15 pm
People fought hard to extend basic welfare benefits to citizens. The foundation is using tax dollars for a national purpose. I think it is intellectually dishonest to propose extending benefits to everyone regardless of citizenship. You need to relate the (national) scope of benefits to the (national) scope of funding.
The intellectually honest approach would be to have a world wide govt for the purpose of raising tax dollars from everyone, based on ‘world’ citizenship, and this being used for cross national border welfare benefits.
But the financial sophisticates on a blog like this would never go there, because their perspective is about reducing the cost of labor to enhance profit. So they wouldn’t support this additional world-govt level tax. It has nothing to do with welfare at all. It conceals an anti-welfare state bias. The fact that health care that included illegal immigrants would never pass is a plus, to you folks.
August 22nd, 2009 at 10:24 pm
Ah, nostalgia. I first found this site on a previous occasion that Surowiecki blogged that you were wrong about something. (http://www.newyorker.com/online/blogs/jamessurowiecki/2008/11/now-is-not-the.html)
There is something about the welfare state that requires nationalism- I think it is foolish to turn away or drive underground people who come to your country to work, but there is a real risk in inviting foreigners to come to your country for the social safety net.
When I was in college in Georgia, the econ honors symposium spent some time on a paper review evidence that states which offer generous safety net programs experience a net migration of benefit-dependent people from states that don’t. A consequence is that Texans get to laugh at Californians for our spendthrift ways as we care for mentally ill, addicted and idle Texans.
All of which is to say, I’m not sure that providing health insurance to undocumented immigrants has a better result than trading with third-world economies which may be more dynamic due to skimpy social programs. Of course, this is clearly not a moral position and I feel the same way about Obama’s “our kids” comment as you did. That’s just embarrassing.
August 23rd, 2009 at 12:30 pm
I think it’s important not to confuse immigrants from illegal immigrants. You use both terms interchangeably, which makes me afraid that you don’t know the difference. Immigration is great, if done legally.
If it’s morally justified to insure illegal immigrants, then where do we draw the line. Maybe we should extend insurance to people in other countries even if they are not in America. After all they get sick too…
August 23rd, 2009 at 11:28 pm
David Rune:
There is a bit of a difference, an illegal immigrant is in the US, contributing to the US economy and weaving his or her family into US society.
Whether one feels that the illegal part is important depends on whether one thinks that the law is just and even if it is just that it is overridingly important.
As Ryan pointed out speeders are breaking the law - does this mean that the EMS should not rush them to the hospital if they get in an accident? After all speeding not only contributed to the accident but endangered other lives as well.
It seems to me that speeding on the highway is a much worse offence than coming to the US illegally. Yet, we don’t yank moral protections for speeders.
I don’t see then how we should yank moral protections for people who are in fact a part of our society even if they got here illegally.
August 24th, 2009 at 10:07 am
“Actually, he doesn???t make the case for it???he just assumes that opposing insurance for illegal immigrants is a shameful, inhuman position.”
I have no doubt that Ryan could make such a case, but aren’t shameful and inhuman enough? I mean, one could probably make a strong argument based on economics or some finer public policy points against human trafficking and slavery, but does one really need to?
August 24th, 2009 at 10:10 am
Then again, given the politics, maybe that case does need to be made. Sigh……….
August 24th, 2009 at 5:32 pm
Karl Smith:
I definitely do believe that there should be some sort of immigration reform.
But, I don’t believe that a broad plan to provide healthcare for illegal immigrants in the right direction. It’s expensive, and it creates incentives to immigrate illegally.
Your metaphor is a little disingenuous. Illegal immigrants do receive some healthcare. They will be treated if they go to an emergency room.
But beyond that I don’t believe that illegal immigrants should receive any further care.