A sore point with some taxpayers is the use of government funds to provide healthcare for immigrants. There are two kinds of immigrants – legal and illegal. Legal immigrants are supposed to be supported by their sponsors so that they do not need government healthcare. That has been government immigration policy since the founding of the republic. In practice, it does not always happen that way. Illegal immigrants, by definition, fail to meet that requirement.
The result is that less-educated, lower-earning immigrants (more illegal than legal) place a burden on healthcare because they cannot afford to pay for it themselves. The nation gets the benefit of cheap labor that lowers consumer prices, but at the cost of subsidizing some immigrants’ healthcare. It is unrealistic to expect sick immigrants not to want medical care and to get it if they can. We are all human. The solutions to this burden on healthcare costs are to clamp down on immigration or to help immigrants earn wages where they can pay for their own care. The former solution would appear to be much faster to implement than the later.
Paying for Healthcare
Solutions to the healthcare problem are many and varied and endorsed and denied by various groups. One reason for this diversity is the variation in the prices paid depending upon who does the paying. What you think may depend upon how you get and pay for your coverage. Here are some examples.
Uninsured individuals, who can least afford high prices, are charged the highest retail rate for services. (Some providers do give discounts to the uninsured, but not the equivalent to the discounts they give large insurers.) Uninsured people fall into four groups:
- Ones who pay their own way.
- Ones who get some form of government or charitable support.
- Ones who get service and simply do not pay for it.
- Ones who do without.
Insured parties get a better price, the savings being proportional to the influence of the insurer in the negotiation process (Medicare vs. Blue Cross Blue Shield).
- Employees of many larger employers have a larger portion of their premiums subsidized by the employer.
- Employees of small employers pay a larger percentage of a larger premium (more total dollars) because small employers lack the bargaining muscle to get lower premium rates.
- Self-employed persons pay the entire premium, providing they can find an insurer to cover them.
The end effect is that the same medical services are paid for at vastly different rates causing issues for both the providers trying to do the billing and the patients trying to pay the bills. Everyone from individuals, to employers, to insurers, to providers has incentive to shift the cost to the other parties in the process. This is the reason some people fear that companies would drop insurance coverage if the government offered an open-ended program. Unless maintaining insurance provides a competitive benefit by attracting better workers or retaining healthier ones, firms will transfer the cost of healthcare to the government, and thus the taxpayers. Cost and coverage still serve as incentives for employees to switch from smaller to larger employers.
So, who really pays what for healthcare?
- Individuals pay some or all direct costs and premiums depending upon their employment and insurance status.
- Employers pay a varying amount of premium charges.
- Taxpayers pay for those covered under government programs (Medicare, Medicaid).
- Contributors to charity pay for the indigent.
- Healthcare providers who donate services pay for the indigent.
- Healthcare providers who are not paid for billed services in effect make a charitable contribution to the non-payers.
- Users of healthcare providers pay "extra" to make up for those who do not pay at all (just like paying shoppers pay for shoplifters).
The government acts a charitable intermediary on behalf of society to provide care for those unable to pay. Ultimately we pay directly as individuals for our own care, or indirectly through taxation, charitable giving, or "upcharging." for the care of others. Only people who pay no medical bills, pay no taxes, and give nothing to charities get truly free healthcare. Everyone else pays. The questions are:
- "Who should get charitable support?"
- "How much should they get?"
- "What is the fairest way to do so?"
You begin the post with an excellent question about how to provide health care for illegal immigrants, then you offhandedly suggest that it would be easier to crack down on illegal immigration than to create a system where they could pay for said health care. I take issue with that suggestion.
ReplyDeleteFirstly, as has been clearly been shown over the years, it is virtually impossible to meaningfully limit illegal immigration. Immigration laws mainly limit legal immigration, which is counterintuitive, but is actually the case. Ergo, the easiest way to reduce the health care costs of illegal immigrants born by the legal citizenry is to reduce the number of illegal immigrants by legalizing them. This would be much easier and quicker to implement than any other solution. They do not need to become citizens (unless they desire so, and then should go through the regular process), they just need to start paying taxes. Hand out tax ID numbers like they are going out of style and start collecting. Costs reduced on a number of fronts: immigration control, public services such as education, and health care as well.
As for your questions:
1. The indigent should get charitable support.
2. They should get enough so that they can receive the health care they need.
3. I do not think that the concept of "fair" is one which should apply here. When devising a system which needs to work for an country of 350 million, it will be impossible to be fair to everyone. The question should probably be, "what is the most efficient and cost effective way to do so?"