Rep. Joe Wilson called out "You lie" when President Obama said that the health care plan would not cover illegal immigrants. On this the President may be technically correct. And certainly that is the politically popular approach to take.
I disagree with the President on public policy grounds. I especially disagree with him because I teach in a public school. And I finally decided to write directly on this topic because of Nicholas Kristof's column this morning. In The Body Count at Home he writes about a young woman who died for lack of health care, about whom T. R. Reid writes in a powerful new book. Kristof writes of her,
Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
That is where I start.
I have not read any of the opinions that grant fairly wide ranging guarantees of health care. Kristof offers us a specific result of these decisions:
My suggestion for anyone in Nikki’s situation: commit a crime and get locked up. In Washington State, a 20-year-old inmate named Melissa Matthews chose to turn down parole and stay in prison because that was the only way she could get treatment for her cervical cancer. "If I’m out, I’m going to die from this cancer," she told a television station.
Perhaps some would argue that we should not be paying excessive medical bills for those incarcerated for crimes against society. Without knowing the reasoning the Courts would use, I would not be surprised that they argue for some basic right to health care when in the custody of authorities - yes, I know that might imply a basic right to health care against which some would argue.
There is also a further public health issue - prisoners are in close proximity, and absent adequate health care there is a real chance of quick spread of infectious diseases, not only among the inmate population but among the guards who have regular contact with them.
That brings me to my specific concerns as a teacher in a public school. There are two places which the courts have ruled an illegal immigrant cannot be denied services. One is medical care in a hospital emergency room. The other is attendance at a public school.
We can argue about the cost of forcing people in general without health care to finally resort to emergency rooms. We all should realize that the hospitals amortize that treatment across the cases of all those who have insurance and/or can afford to pay on their own. And that treatment is often far more expensive than medical intervention earlier would be - this is something we all know, and is part of the underlying argument for almost universalizing health care.
Except we exclude the undocumented, those some categorize as illegal aliens. Already most have trouble obtaining medical care, because they cannot legally work, and what employment they can obtain usually does not include the health care most of us receive through our employers. If there are cost and public health issues for uninsured American citizens and legal immigrants with green cards (many of whom work in places that do not offer health care to employees), how do we solve either the public health issues or the financial issues by excluding a group that exceeds ten million people perhaps reaching as many as 15 million undocumented?
And if one concern about inmates is their concentration, think about the number of contacts any person in a school with several thousand students has during the course of a day. I know that with our more than 2,800 students and several hundred staff members, someone sick can easily infect hundreds in one day. In the case of swine flu we can see the impact at Washington State, where more than 2,000 were reported infected.
Or think of the number who would be exposed if one or two very sick people traveled by a public transit system such as NYC subways or Washington's Metro. One very sick person is effectively a biological weapon directed at those with whom s/he comes into contact. How we can we claim we are protecting America and allowing such exposure?
Oh, and let's return to prisons. Some there are undocumented aliens who have not merely violated immigration rules, but have also committed serious crimes. While they are in our custody, they get free medical care. So our tax dollars already pay for medical care for some "illegals" - in prisons, and in those hospital emergency rooms, whether they receive direct tax support (and some are public hospitals, many are teaching hospitals supported in part by taxes) or not (because there are patients insured through medicare, medicaid, SCHIP, and public employee policies whose costs in the emergency room include the unreimbursed costs for people without medical insurance treated there, including undocumented aliens).
If we view medical care as a basic human right - and I for one do - then that is no more contingent upon one's immigration status than is life itself. Do we deny undocumented aliens the right to purchase food? Do we require them to be homeless, not allowing them to rent a place to live? Do we require them to be naked, not allowing them to purchase clothing? If not, how then do we attempt to deny them basic medical care by denying them means of paying for it? And if we accept the words of Matthew 25 that we heard at the funeral of Sen. Kennedy, can we in that Gospel find any distinction among those of whom Jesus speaks of as his brothers?
I recognize the politics of the issue. And I do not entertain any fantasy that the words I offer here will in anyway changes those politics. But I feel compelled to speak of the morality of the issue.
And the basic humanity of it as well. What point is there to say that the child of an undocumented worker is entitled to attend a public school when the family is barred from the basic health care that can ensure the child does not have excessive absences and thus fall irreparably behind in her school work? Perhaps we can at least insure the children - even if they are "illegals" - through SCHIP. Yet the logic that would deny their parents medical care would seemingly deny the children, unless those children were born in the US and thus citizens by birth.
But then consider - a family enters illegally with one child, then later has a second born here. One is a citizen, one is not: will we attempt to keep one healthy and not the other? Does that make medical sense? How can it make moral sense?
I had trouble sleeping. Often when I am thus awake in the middle of the night, my thoughts seem far more clear, at least to me. This diary is the result of something that - at least to me - is obvious on so many grounds: public health, educational soundness for children, basic humanity.
When I volunteered at the Remote Area Medical Mission in Wise VA in July, I know that those doing registration did not check the immigration status of those we served. Nor should they have done so. The event was also sponsored by another group, Missions of Mercy. Mercy does not screen those to whom it offers solace.
Perhaps our President does not feel he can address this issue. I am not bound by office. I not only can speak about this issue, I feel obligated to speak out, to write about, because it is to me so clear.
How about to you?
Peace.