YOUR VOICE: Let compassion, fairness guide health care debate

It is the end of a very busy day in the farm worker clinic in the Yakima Valley where I work as a physician several weeks each month.

My last patient is a 66-year-old migrant worker from Mexico we shall call Herman. Herman has had a severe cough, fever and chills, chest pain and dizziness for a week. He has put off seeking care for as long as he can, but he just can’t manage to continue working in the hop fields in the 100-plus degree weather.

His X-ray shows pneumonia and, in addition, a mass. His oxygen is low and he is breathing hard, but he will not go to the hospital. He cannot afford tests and hospitalization without insurance. Although he will not say, and we will not ask, he worries about his immigration status and what could occur if it is discovered. He is the main wage earner for an extended family here and in Mexico.

We do our best to treat him in our clinic and hope for the best, but the prognosis for his pneumonia is not good. Furthermore, the mass will never be worked up since he will not get a CT scan, let alone the specialized care required.

At best, the local hop grower will lose a productive and dedicated worker. At worst, a family, including an elderly grandparent and several children, will lose their financial support.

The really distressing side of this situation is that Herman’s story is not uncommon. Undocumented noncitizens go without needed care more often than we can imagine.

As a physician, I have listened with much interest and concern to the health care debate. Many topics and issues have been raised, and some have been based on myths, rumors and misinformation. Among these issues within the health care debate is the subject of health care for undocumented, noncitizens. As a physician, I recognize that this is an area where we can use a better education.

First of all, let me make it clear that I do not believe any of the health care reform proposals now before Congress actually states that free health care for undocumented noncitizens will be included. So, let us put that behind us.

What I wish to do is lay out my reasons for proposing that we should provide health care for all persons, documented and undocumented, citizens and noncitizens, residing in our country.

As physicians, we are dedicated to serve all who are in need of care. We are not law enforcement and should not be forced to decide who is “legal” before we care for them.

Do any of us want to be the one to turn away an 84-year-old woman with a possible heart attack or a 3-year-old child because they do not have the necessary documents? Our country was founded in part on the principle of welcoming all who wished to come. We are, after all, a nation of immigrants. Among many reasons, this compassion for others is one of the most significant reasons I am proud to be an American.

From the perspective of fairness, it is arguable that immigrants contribute more to our economy than they use in resources, including health care. In an August 2005 article in the American Journal of Public Health, Drs. Sarita Mohanty and Steffie Woolhandler pointed out that the Social Security Administration has estimated “that workers without valid Social Security numbers contribute $8.5 billion annually to Social Security and Medicare.”

In addition, whether documented or not, all people pay sales tax, fees and tolls. Furthermore, businesses and people in Eastern Washington do not have to be convinced of the value of undocumented workers to their economies where the agriculture business, and all the businesses that rely on agriculture, would cease to function without these laborers.

From a utilization point of view, Mohanty and Woolhandler found that “health care expenditures are substantially lower for immigrants than for U.S.-born persons” ($1,139 vs. $2,546 per capita total health care expenditures). It appears that undocumented immigrants not only pay for much of their health care, they end up using less of it than many persons believe.

Should you not be convinced by my arguments for compassion and fairness, then consider how denying care to this population affects all of us in terms of health care costs.

Many are unaware that the law already requires that all persons, regardless of their documentation or citizenship, be offered medical care. This applies especially to our emergency rooms.

While our emergency personnel provide excellent care, it is expensive. An undocumented noncitizen (and this also applies to all of us who are uninsured) who is not covered by our health care system will put off getting health care until it becomes an emergency, requiring much more expensive emergency care, costs that are passed on to each of us.

In addition, from a public health perspective, it also makes sense to encourage all persons to get health care when ill. Untreated tuberculosis, swine flu and other communicable diseases need to be contained, and one of the best ways to encourage the spread of such diseases is to discourage persons with these illnesses from getting care.

It is time we stop letting misinformation, propaganda and fear guide our decisions about our health care system. I encourage everyone to do the research for themselves.

A better way to approach this complex issue is to let our compassion, sense of fairness and intelligence lead the way to a truly American solution.

Peter Kliewer is a Tacoma physician.