Unless the physicians can succinctly argue their case for care and services, the managed care entity will, for reasons of medical necessity, deny access to care and services.
What Cost-Added Ratio Based on Illegal Immigrant Population?
The argument by opponents that loopholes exist that would allow illegal immigrants to access Obama's proposed legislation on healthcare services is rendered moot in lieu of the fact that those illegal immigrants are currently receiving healthcare services Medicaid and through Immigration and Naturalization Services (INS). The Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens states:
"Section 1011 of the (Medicare Prescription Drug, Improvement, and Modernization Act (MMA) (P.L. 108-173)) MMA appropriated $250 million dollars in FY 2005 through 2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other non-specified citizens who are not eligible for Medicaid (Centers for Medicare and Medicaid Services, 2009, found online, p. 68)."
The Federal Government has long reimbursed providers for emergency services to undocumented (illegal) aliens. Opponents are not looking to the past costs of providing that care, but to the future cost of it, and it is not the cost of services to undocumented workers that would increase the cost to taxpayers, because they have been paying that cost for decades; but is the cost of U.S. citizens and legal immigrants whose incomes, in conjunction with the rising costs of managed care business practices resulting in increased patient shares, have made access to affordable healthcare premiums privately or through employer-based plans unaffordable to them. Here, we have demonstrated that the segment of the population that would benefit from this plan is not the undocumented illegal alien in the Hispanic segment of the CDC uninsured segment previously cited, but the legal U.S. citizen and immigrant or resident.
Why We Should Provide Healthcare to Undocumented Persons
When we consider the proximity of Mexico to the United States, indeed, Mexico and Latin America; we should have a strong and proactive interest in maintaining the health of those individuals in the southern continent, and especially those who cross the border into the United States illegally. The recent Swine Flu outbreak should serve to help reinforce that rationale. Infectious diseases are contagious, and if we do not take steps to treat to cure illegal aliens entering the country, and deport them with contagious diseases like tuberculosis and HIV / AIDS, then the risk of transferring those infectious diseases, and a plethora of other infectious diseases, to Americans increases with each case we deport to Mexico and Latin America without treating. This is especially true in the case of tuberculosis, a disease which can alter itself to immunity to known cures. To withhold or deny treatment and medical care to illegal aliens is putting at risk each and every person that comes into contact with that person. Also, sending them back to their country of origin without follow-up care means that likelihood that they will seek or receive proper care to resolve the disease once returned is increased, and the disease will mitigate any treatment medications used to combat it without follow-up to cure, potentially creating a new and untreatable virus or disease.
The estimated cost, according to a Center for American Progress report by Rajeev Goyle and David A. Jaeger, PhD (2005) estimated the cost to deport back to their country of origin all illegal aliens, some 10,000,000 people, to be approximately 206 billion dollars over five years (p. 3). This solution is not feasible for numerous reasons. First, the nature of immigration law would prevent the immediate deportation of the illegals, and the estimated 206 billion dollars would probably increase exponentially with the cost of immigration court, legal, and other costs. Add to this cost, too, the cost of Border Patrol, which Goyle and Jaeger estimate would be 14.95 billion over a five-year period to find and arrest the 10,000,000 illegal aliens (p. 11). Consider, too, that many deportees have been found to reenter the United States after having been deported, and we then can see the vicious cycle this idea presents. Providing healthcare services to the undocumented persons, especially those who work and would be in the income levels where they would contribute to the cost of the premiums for coverage, could ostensibly decrease the cost of healthcare the United States is currently paying for undocumented persons. The cost over a five-year period would certainly be less to provide healthcare coverage to those undocumented people than would be the cost associated with searching them out, arresting, putting them through the legal systems, and subsequently deporting them.
Is Obama's Plan Ready for Implementation?
The answer to whether or not Obama's plan is ready for implementation, or whether or not it requires additional work, is yes to both questions. The solution, however, is not to delay, but to implement the plan so that the real and working components of the plan can be identified through utilization, and then addressed legislatively. Especially as it concerns the uninsured, including undocumented illegals, the plan should be implemented as soon as possible. The plan would reduce the cost of healthcare delivery, because the uninsured would have access to physicians as primary care sources, instead of emergency rooms, where the cost for non-emergency conditions is dramatically higher than the cost of a physician's office visit.
In his book, Wounded Profession: American Medicine Enters the Age of Managed Care (2002), Arnold Birenbaum says:
"The popular fear of the early Clinton years, that governmental-led reform would restrict the freedom of doctors to make medical decisions and patients to choose their providers, is past. Today, change is driven by the market place. It is most obvious in the widespread indifference among buyers of care to the plight of the uninsured and the embarrassment of providers who can no longer afford to cross-subsidize care for the uninsured. Managers of delivery systems are expected to practice cost-containment, not give away services. Investor ownership of managed care plans has created an environment in which providers are more scrutinized than dimpled ballots in Florida (pp. 37-38)."
What Birenbaum is saying, in short, is that in order for a publicly traded entity to demonstrate growth, it must demonstrate increased profits. In healthcare, the only way to increase profits is to decrease the entity's cost to the medical provider of care under private and employer-based plans. In our system, the only way that can be done is by withholding care, delaying care, thus delaying payments, denying care in those cases where the outcome is inevitable terminal demise of the patient, and by increasing patient shares and deductibles such that, as we now see, they become unaffordable to the members of the plan, and those members drop off, becoming uninsured, or electing not to take coverage at all.
Obama's plan satisfies the communitarianism and the utilitarianism theorists, because it addresses both ideologies. This does not mean that Obama's plan is perfect, but it does mean that it is feasible, and that the arguments targeting undocumented persons is a frail one in lieu of the evidence to suggest that it is not, after all, the undocumented person who is responsible for the increasing cost of healthcare. What has been shown here, too, is that the much touted argument that the market will take care of itself is an argument that no longer is one of substance, because it was the market that brought about the current crisis in healthcare that Obama has pledged to change.
Birenbaum, A. (1997). Managed Care: Made in America, Praeger Publishers, Westport,
Birenbaum, A. (2002). Wounded Profession: American Medicine Enters the Age of Managed Care, Praeger Publishers, Westport, CT.
Centers for Disease Control and Prevention (2009). Uninsured Americans: Newly
Released Health Statistics, CDC Features, found online at http://www.cdc.gov/Features/Uninsured/, retrieved November 15, 2009.
Centers for Medicare and Medicaid (2009). Department of Health and Human Services
Fiscal Year 2010 Budget in Brief, May 7, 2009, found online at http://www.hhs.gov/asrt/ob/docbudget/2010budgetinbrief.pdf, retrieved November 17, 2009.
Focus on Health Reform (2009). Care Reform Proposals, found online at http://www.kff.org/healthreform/upload/healthreform_tri_full.pdf, retrieved November 16, 2009.