Reagan's Gift: Free Medical Care for Illegal Aliens

Ronald Reagan signed into law the bill that requires local hospitals to provide free emergency medical services to illegal aliens. This was in 1986: the Emer­gency Med­ical Treat­ment and Active Labor Act (EMTALA). Here is a summary.

The law was designed to pro­vide patients with access to emer­gency med­ical care and to pre­vent hos­pi­tals from "dump­ing" unsta­ble patients that could not afford to pay for their care. "Under the law, "any patient arriv­ing at an Emer­gency Depart­ment (ED) in a hos­pi­tal that par­tic­i­pates in the Medicare pro­gram must be given an ini­tial screen­ing, and if found to be in need of emer­gency treat­ment (or in active labor), must be treated until sta­ble." . . . Although the law refers specif­i­cally to hos­pi­tals with an ED, the guide­lines from the fed­eral gov­ern­ment have applied EMTALA require­ments to all facil­i­ties that par­tic­i­pate in the Medicare pro­gram and offer emer­gency ser­vices.

The irony here is that the inevitable results of this law are cited over and over by conservatives who call for the deportation of illegal immigrants. Sometimes they mention free education in tax-funded schools, but it is free emergency medical care that they think justifies deportation.

There are two ways to solve this. First, pass a law repealing this law. Second, deport all illegal immigrants. I favor the first. Let me explain why.

COSTS AND BENEFITS

In response to my article on the impossibility, economically speaking, for the federal government to deport five million families who are inside the United States, I got what is by far the most common reaction to my analysis. The critic pointed out that illegal aliens use the welfare system to get benefits.

The person did not mention the fact that the federal government would have to spend a minimum of $100 billion to deport the targeted five million families that are supposedly going to be protected from deportation by Obama's executive order. That does not count the additional five million families, or possibly 10 million families, that are not expected to be covered by this Executive Order.

It also does not factor in the obvious fact of economics: the rising cost of implementing any policy by the federal government. As the easy targets are picked off, the remaining targets become far more expensive to deport. This is an economic phenomenon known as the law of diminishing marginal returns. It costs something in the range of $23,000 to deport one family today. We can be sure that after the first million or so families being deported, this cost will get much higher. It will easily go to $200 billion. It could go much higher. The last 250,000 will be astronomically expensive to deport.

Nobody talks about this. Almost nobody wants to talk about the vast expansion of federal power in our lives to enforce such a program. Nobody talks about the enormous rise in the federal deficit that this would cause. All they are worried about, or so they say, is that there will be more aliens in the public schools.

There is a simple solution: cut off all government funding of education. But that is not what most pro-deportation conservatives have in mind. They support public schools. They just want to get control over them politically.

There is a cheaper way to solve this than deportation. The federal courts have decided that local schools must provide free education for all children, including illegal immigrants. This could be called to a halt by the new Congress on January 2, 2015, or at any time thereafter. The two houses could, by majority vote, remove education from the jurisdiction of federal courts. Obama would have nothing to say about this. The Constitution says this.

In all Cases affecting Ambassadors, other public Ministers and Consuls, and those in which a State shall be Party, the supreme Court shall have original Jurisdiction. In all the other Cases before mentioned, the supreme Court shall have appellate Jurisdiction, both as to Law and Fact, with such Exceptions, and under such Regulations as the Congress shall make (Article III, Sect. 2).

In any case, Spanish-speaking kids can get a first-rate education free of charge on the Khan Academy in Spanish. They don't have to come to the USA. It is a lot cheaper to buy a used computer and hook up to the Internet than to try to get across the Mexican-American border. Also, with Outernet feeding free information through a cheap, solar-powered Lantern receiver, a student will not even need an Internet connection.

LOCAL HOSPITALS

With respect to local hospitals, which are required by Reagan's law to treat illegal aliens for emergency care, this law can be changed. This is the cheap way to solve the problem. If Obama resists, then his successor may not. In any case, the problem originated in Washington. If Washington cannot solve it by simple repeal, why should anyone expect Washington to solve it by deportation?

Here is the threat. In order to locate illegal aliens, some Congressmen and the executive will once again press for a national identification card for employment. "Your card, please." This would mean having federal bureaucrats police small businesses around the nation, because these are the businesses that tend to employ illegal aliens. The deportation crowd is willing to surrender American liberties to the federal bureaucrats regarding employment, and is also willing to run massive federal deficit on a permanent basis to deport these people, all in the name of protecting the local American welfare system: free schools and free ER treatment.

Here is the underlying basis of the argument. These critics understand that middle-class voters have joined with liberal reformers to create a massive welfare state in the United States. This began in earnest during Franklin Roosevelt's New Deal. It is bipartisan. It is Keynesian. It is universally accepted. It is the use of political coercion to extract wealth out of people who are richer, in order to gain benefits at their expense. It is a massive system of legislated theft.

These people are convinced that the American welfare state is morally justified. Furthermore, they think it should be continued. Anything that would place any additional burden on the existing distribution of the local loot -- for that is what it is: loot -- is rejected. Those who got in on the looting early, and who are benefiting from it now, deeply resent the fact that illegal aliens may get into the country, and then get their hands on some of this loot. It's just not fair, they insist. What's fair is the existing system of looting; a bunch of foreigners should not get access to it. "We got here first."

This assessment rests on an assumption, namely, that illegal aliens are trying to get into the United States primarily to get in on local welfare benefits. The United States-based American relatives of poverty-stricken people pay drug-smuggling gangs $10,000 to get their relatives across the Mexican border, at the risk of dying in the desert, and at the risk of kidnapping, rape, and other horrors. Why? In order to get their relatives access to free ER care. They risk the big statistical emergency -- crossing the border -- to get support for a little statistical emergency: ER care at a local hospital.

This criticism of immigrants assumes that there is no system of government-subsidized medicine in Latin America. This outlook also assumes that the level of care in Latin American medical facilities is low. On the contrary, it is pretty good, at least in Mexico. For the average guy in the street, it is a good deal better than it is in the ER wing of an American hospital.

MEDICAL CARE IN MEXICO

Fred Reed, an American expatriate living in a small town in Mexico, writes this.

Americans tend to think that medical care in Mexico is primitive, probably involving chanting and the burning of feathers, and suffers from filth, ignorance, and reuse of needles. The following is a list of medical experiences of which I am personally aware, that is, of my family and friends. It is not cherry-picked: There are no horror stories that I leave out. Natalia manages to fall through a glass door in Guadalajara and severs three tendons in her wrist. A passing motorist takes her to the civil hospital. A surgeon reattaches the tendons. Result: hand is normal. Cost: Zero. The wife of a friend has bilateral cataract surgery with IMSS, the Mexican Institute of Social Security, whose insurance costs $300 a year for gringos. Surgery successful. Cost, apart from the annual premium: zero. My crazy friend, Willy I'll call him, trips over a cat (really) in San Miguel de Allende and badly dislocates his shoulder. In agony, he goes (with me) to El Hospital de la Fe, which is private, and is instantly cared for. Two sets of x-rays, IV anti-inflammatories, night in a private room, services of neurologist and orthopedist, general anesthesia to pop the joint back in place, etc. Result after two weeks: slightly sore but functioning. Net cost: $790 US. Analysis from Willy, who was for years a paramedic in New York City, and does not gladly suffer fools, or much of anybody else: "I was damned impressed. They did everything right, and they were just nice people." No ego-struck God-figures.

None of this is grasped by Americans who argue that immigrants are coming to the USA to get free medicine.

DEFEND THE WELFARE STATE!

Anyone who invokes "immigrants in the ER" is arguing that the welfare state is moral, but only for registered voters and legal citizens.

I ask: why shouldn't it be shut down? Why shouldn't it be de-funded? Why should we worry that illegal immigrants may somehow lead to its bankruptcy a little sooner? It deserves to die. Why not speed it along to insolvency a little faster?

In any case, local ER costs are chump change compared to Medicare and Social Security -- the federal welfare state for the native-born American masses.

Spare me the crocodile tears about ER costs. Shut down the whole system: from the local ER to Medicare. Stop worrying about what is a done deal: immigrants in America. There is no money to deport them. The court system will be totally jammed if the immigration authorities ever attempt to deport five million families, let alone 10 million or 20 million.

I grow weary of rhetoric defending the welfare state from immigrants. My solution: shut it down. That is the best way to keep immigrants from exploiting it. If there is no politically stolen loot for all Americans, there will be no politically stolen loot for illegal immigrants. But this proposal is too radical for the opponents of free schools and free ER care in local hospitals for illegals. They are committed to the local welfare state -- and the federal welfare state even more.