Monday, August 24, 2009

Immigrating for Health Care

I wanted to expand on a Tweet I made over the weekend:

In a market where people paid cash for #healthcare; People would be treated equally regardless of immigration status.

America's vast population of undocumented immigrants is the largest block of uninsured Americans. They are also the most underserved population in the health care system. Even when an undocumented immigrants are covered by insurance, they are unlikely to receive the full benefits of their policy.

It is easy to intimidate illegals away from using services. If you cost too much; You get deported.

A system of self-funded care would not have the same inherent inequalities. An illegal immigrant paying cash for services would be as welcome as any other cash paying customers.

The large number of people who travel to the United States specifically for care provide a case in point. For that matter, people traveling to the US for health care have a positive impact on the balance of trade.

The fact that illegal immigrants are treated as burdens by third party pools is a sign that systems of pooled insurance are not the ideal mechanism for funding health care.

When we surrender our health care to a third party pool, we make the quality of our care dependent on the financial health of that pool. The financial health of pools depends on the balance of healthy and sick within the pool. A pool with a relatively high ratio of healthy to sick thrives. One with a low ratio of healthy to sick perishes.

Pooled insurance creates the vehicle for the politically powerful to manipulate the make up of pools. When politicians are able to shift people from pool to pool they can reward friends and punish enemies in the industry.

The long and sullied tradition of gerrymandering shows that politicians are not above using populations for their political ends. For that matter, there is long and sullied history of war in which generals burden their opponents with large numbers of sick and injured.

Pooled insurance creates a vehicle for political manipulation of populations.

As I recall, the US has only about 5% of the world population, meaning we have only 5% of the sick and elderly. With pooled insurance and lack immigration control, it is possible for the power players of the world to thrust their sick and elderly on us in a game of international politial war.

Problems exist dometically, a central feature of HR3200 is the creation of committees of unelected bureaucrats that can manipulate insurance pools by forcing pools to take on policy holders that they would not otherwise accept.

The status of undocumented workers in pooled insurance is problematic as they are a population easy to manipulate and bully about. The political class can force illegals to buy insurance when they are healthy and shove them out into the cold when they are sick.

Illegal immigrants can also be used as weapons of business war. If a politically connected player can foist a large number of sick illegals on the pool of an enemy, then they can swamp the pool.

HR3200 turns the healthcare of the people into a big political game with political insiders jockeying for control over the definition of health care pools.

I dislike when President Obama stands on the stage and claims that illegal immigrants are not part of the HR3200 health care reform effort. If the most underserved segment of the population in this nation is not part of the effort, then the effort is bogus.

If his statement is true and illegal immigrants are not included in the HR3200, then passing HR3200 will make real immigration reform even more difficult as the reform will suddenly be driven by the cost of including illegals immigrants in our nation's health pools and not on questions about what is best for the immigrants.

Our system of using third party pools adds a very ugly dimension to the immigration debate. Our growing dependency on pools makes people see immigrants as a threat to the health care.

The fact that Obama is not eager to talk about how health care reform will affect the most underserved segment of the population tells me that pool insurance is the wrong direction for health care.

Conversely, I believe that a system of self-funded care is the best mechanism for undocumented workers as the funds they are able to use the funds they save for care without fear of retribution.

I realize that this post is convoluted. In systems of pooled insurance, the transient population becomes pawns. In a system of self-funded care, the transient population is able to build and use health care resources on a more equal footing.

IMHO, the mistreatment of transient populations by pooled insurance is an indication that pooled insurance is inferior to self-funded care.


Scott Hinrichs said...

As the son of an immigrant, I am generally opposed to the scapegoating of the immigrant population. One of the main complaints against the immigrant classes (this was already a problem during the American Revolution) has long been the general burden imposed on society. Sometimes this is couched in cultural terms; sometimes economic.

The benefits of immigration are discounted. Perhaps this is because it is far easier to see cultural clashes than it is to see dispersed (and often delayed) benefits.

This problem is exacerbated by policies of the welfare state --- the wealth transfer state --- which puts many newer immigrants into the recipient class, creating larger claims on the payer class and competition with longer-term members of the recipient class.

The answer to this, many assume, is to force reduction of the number of immigrants, when a more appropriate answer is to change the welfare state paradigm.

RD said...

In fact 6 million illegal immigrants have private insurance through their place of employment.

Most illegal immigrants pay for social security and medicare from their paychecks just like the rest of us. (Yea i know their are some payed under the table, this is true of people here legally as well however).

The problem with illegal immigration has more to do with the associated crime problems in human and drug trafficking.

egb said...

I've commented on HR3200 also. The most immoral aspect of it is it make matters worse for the poor when heroic medical care is needed. When the "Secretary" says an 85 year old person cannot have a bypass operation, the decisions is final. THere is no judicial review of decisions made by the Secretary. Today, a poor person could appeal to the state insurance commissioner or sue. Not so with HR3200.

egb said...

I've proposed HSA's plus catastrophic health insurance as the complete set of tools to improve our health care system beyond any other in the world. Your suggestion for a Health savings and loan sounds similar. With mine, HSA's can go in the red and the gov picks up the tab. HSA's also are transferrable but not convertible to money. They can be used to pay the premium of CHI during periods of unemployment. Finally, depending on the amount you build up, they can be used to pay for the bypass of a 98 year old person if that is what he and his family want. Does your thinking cover these issues?

Ed Bradford
egbegb2 AT gmail DOT com

RD said...

Your comment on HR3200 is outright wrong, The thing you are referring to is a consumer reports for health care so that you know what is actually effective.

At no point does any individual in the government make any decisions what so ever about the care received by anyone.

May i suggest you pull your head out of your rear.

Here is a link to the bill so that you can actually read it.

HR 3200

If you want to argu the merits of health reform lets start with what is actually in the bill. Arguments about cost, socializing medical care, Ideological beliefs should be where we start not pretend problems invented by Dick Army and Obama as hitler sign toting loons.