http://www.investors.com/editorial/IBDA ... e=20060616

ERs And Illegals

Posted 6/16/2006

Immigration: New reports on the crisis in emergency care points to one of the many social costs of importing low-wage workers. Reform that ignores those costs may only make them worse.

The Institute of Medicine, an independent body that advises the federal government on health care issues, has done a checkup on America's hospital emergency rooms and found them close to a breakdown.

In three reports issued Wednesday, the institute found ERs to be under-funded, understaffed and unprepared to deal with a major disaster such as a pandemic or terrorist attack.

Dr. Brent Eastman, the chief medical officer of Scripps Health in San Diego, said he hopes the reports will "astonish the nation."

Far from being astonished, though, Americans who have been reading or watching the news for a few years may simply be dismayed that a problem so well known for so long hasn't been solved.

As the institute noted, ERs are the primary source of health care for many of the uninsured. This situation is the worst of all worlds for hospitals, which see high-cost facilities tied up by people who usually don't need them and are not likely to pay.

To get to the root of the problem, we must identify just who the uninsured are, why they are uninsured and who should bear the cost of insuring them. And answering those questions or trying to act on the answers has long been politically tricky.

It's no secret that, along with those uninsured by choice or unable to get coverage, there are many, probably millions, who might be called the imported poor. These are low-wage workers and their families filling low-wage jobs in agriculture, construction and services, and are frequently undocumented.

The number of illegal immigrants lacking health coverage can't be pegged with great precision, but it can be inferred from data on health coverage and the foreign-born.

According to Census data issued last year, 44% of immigrants who were not naturalized citizens likely lacked health insurance.

This was more than three times the share for the native born (13%) and much higher than that of naturalized citizens (17%).

The Census figures don't break out the coverage levels for illegal immigrants. But it's obvious on the local level, at least, that care for illegals is a huge part of unreimbursed hospital costs. In Los Angeles County, for instance, it's estimated that 60% of uninsured patients are noncitizens. And more than half of these are illegals.

The ER crisis is typical of the costs to society that come with unlimited immigration of low-wage workers.

First, the impacts vary by location. So many of those who reap the economic benefits of this immigration do not directly deal with the downside in their local systems of health care, schools and law enforcement.

Second, the role of illegal immigration is often obscured by those who want to pursue an agenda other than immigration control.

Many schools are failing, for instance, not because they have too little money, but because they are overwhelmed by unprepared, non-English-speaking children.

The public-school lobby uses their plight to ask for more money. Democrats ignore the impact of imported cheap labor on wages in general, preferring instead to blame the Bush administration if workers don't see their pay rise. Advocates of government-run medicine like to cite the high number of the uninsured as evidence that the current public-private system must be replaced.

What's a bit different this time around is that the immigration issue is not being buried. Congress is taking it on and, despite deep disagreements, may yet come up with a reform law. We see both an opportunity and a threat here.

The opportunity is to make rules for current illegal immigrants (and those that come later) that force them or their employers to pay more directly for services such as health care.

One interesting idea is to require health coverage for all guest workers, paid for by employers, the workers themselves, charities or whoever else wants to pony up. The threat is that Congress will be so focused on the benefits of low-wage labor that it will ignore the costs and pass a bill that essentially imports more poverty.

That would be a huge mistake. As our nation's troubled ERs can show, we import too much already.