Skip to comments.Catastrophe in Care:Hospitals are being crippled by the costs of treating migrants
Posted on 06/12/2005 12:48:10 PM PDT by axes_of_weezles
The Medicare reform bill passed in 2003 allocated $1 billion to reimburse states for federally mandated ER care given to illegals--about $45 million a year of that to come to Arizona over four years. But even that, some hospital staffers say, is little more than a Band-Aid on a huge problem. A mere 22 years later--again, in part because of EMTALA--Cosman says the system is coming apart, with most trauma hospitals having left the network, along with physicians, surgeons and others. As with most issues related to the illegal invasion, those who live along the Mexican border, the scene of the crime, have the best view. Where health issues are concerned, it's not a pretty sight.
Residents say they've come across ground dotted with discarded pills, syringes containing nobody knows what, and used needles. Some report riding horses along creek beds, popular pull-up areas for groups heading north, and finding 70 or 80 piles of human feces, some of it blackened and running with blood.
It's as disgraceful as it is disgusting--and it raises a question: What happens when rain washes all this into the water supply? Is it a threat to spread diseases such as hepatitis? Some believe it might be.
What happens when cows drink from these contaminated creeks? And what happens when this constant flow of Third World humanity goes north, fanning out all across Arizona and the country? What kind of diseases do they bring with them?
Chagas, a potentially fatal illness spread by contact with the feces of the reduviid bug, called the "kissing bug," is prevalent in South and Central America. Fifteen million people in that region are infected with the parasite, and 50,000 die of it every year, according to the World Health Organization. A person can be infected for 10 or 20 years or more before showing symptoms, making it particularly insidious. At its most severe, the disease can cause the heart to fail, and literally explode.
In the United States? Louis Kirchhoff, of the University of Iowa Medical School, estimates that between 80,000 and 120,000 Latin Americans with Chagas live here. Matching prevalence studies and immigration numbers, Kirchhoff figures about 10 Chagas-infected persons entered every day from Mexico alone in the 1990s.
The disease can be transmitted four ways, but for Americans, the most worrisome is the blood supply. In the United States overall, the chance of contracting Chagas from a blood transfusion is small, one in 25,000, according to David Leiby, a research scientist at the American Red Cross in Washington.
But in cities with high populations from Latin America, the numbers fall to much riskier levels. In Miami, for example, the chance is one on 9,000. In L.A., 1 in 5,400.
Researchers have confirmed seven cases of people contracting Chagas through blood transfusions--five in the U.S., two in Canada--and they say the number of unknown cases is probably much higher.
"A rate of one in 5,400 is something we're concerned about," says Leiby, adding that the FDA is still a few years away from a useable blood-screening test. "Chagas is overlooked by the health care system in the United States. Our physicians aren't aware of it and wouldn't recognize it in most cases."
Tuberculosis, which also shows up in high rates in Mexico, is migrating north as well. Many assume a place like Cochise County, right on the border and overrun by illegals, would have a high incidence of TB. But it doesn't, says Edith Sampson, of the Cochise County Health Department. "The immigrants only pass through here on the way to Atlanta, or whatever city they're going to," she says.
Exactly the problem--which is a big reason why 53 percent of the TB in the United States in 2003 was among foreign-born persons, up from 29 percent in 1993, according to the Centers for Disease Control. In L.A., again because of its huge illegal population, the figure is closer to 80 percent.
Only 15,000 Americans suffer from active TB, the only dangerous kind because it can be passed to someone else, usually by coughing and expelling the bacteria from the throat or lungs. That's a small number, but the New York Academy of Sciences estimates that each victim will "infect 10 or 20 or more people--in whom the disease will likely remain latent, creating the potential time-bomb effect."
The State Health Department says that Arizona had 295 reported cases of active TB in 2003, a jump from the previous year. Why the increase? More of the disease was found among kids under 5 years old and prisoners. The latter were mostly Immigration and Customs Enforcement detainees--in other words, illegals.
Sixty-eight percent of Arizona's foreign-born TB cases are from Mexico, says state health. Will TB return to the United States in a big way?
It hasn't yet, says Lee Reichman, executive director of the New Jersey Medical School's National Tuberculosis Center. But he adds that with globalization--the ability to get around the world in 20 hours--and because "we can't stop people from getting in to this country, no matter how hard we try," the potential exists for a new epidemic.
His particular concern is with multi-drug-resistant TB, fatal in 60 percent of cases. This strain requires a long regimen of costly drugs that illegals are unlikely to take, or have access to. Arizona has a small number of MDR-TB cases, and all of them in the past five years have been among foreign-born persons.
"The reason you haven't heard about TB here is that good public health is working," says Reichman. "People who are symptomatic go to physicians, and the physicians don't ask questions. As soon as you have to ID yourself, or say we're going to send you back to Mexico, these people go into hiding and spread more TB. Any physician who cares about being a physician isn't going to ask those questions, because he took an oath to treat sick people."
The Copper Queen's Rush Kish says that under Medicare reimbursement guides, her hospital cannot ask patients if they are in the country illegally. But how do you bill the feds to get money back for treating illegals if you can't ask if someone is illegal?
Well, you play a little Orwellian word game, probing around the issue with a list of government-approved questions, then make educated assumptions. But the illegal holds the trump card, because he can refuse to answer every question. "We don't know yet what evidence Medicare will accept when we apply for reimbursement," says Kish. "But at least we can begin documenting the enormity of this problem."
The question isn't whether those with genuine emergencies should get treatment. Of course they should. In Naco, residents have no access to ER care and many would die if they didn't get to the Copper Queen. The real question is: Who pays?
Rev. Tom Buechele, pastor at St. John's Episcopal Church in Bisbee, thinks it's appropriate for the federal government to keep ponying up, as long as American companies "maintain their illegal trafficking in human labor."
"Until we have comprehensive immigration reform, we need to bear the health-care costs for undocumented workers, whatever those costs are," says Buechele, who, for almost a year now, has been running a free monthly clinic in Naco, Arizona, catering to the poor and uninsured on both sides of the line.
Although they talk a different language, politicians, even Republicans, promote policies that further Buechele's liberal vision. They boast to constituents that they've saved border hospitals by pushing through the Medicare reimbursement plan, which provides a relatively small amount of money over four years.
But that's another Hobson's choice, which is to say no choice at all. What do you do, let hospitals go under? Kyl, who pushed to get the reimbursement money, says an emphatic no.
"If we want those ERs to be there for us, then we'd better keep them in business," says the Arizona senator. "If our hospitals are required by federal law to treat anybody who comes into the ER, and the federal government has failed to control the border, then it's appropriate for the government to reimburse these hospitals."
But some argue that the system as it stands now, with EMTALA firmly in place, is rigged to produce two results: The federal treasury will remain wide open to illegals, and that all but guarantees that more and more of them will bust the line to get here.
After all, this is the end of the rainbow for them, where jobs await, education is free, health care is free. Who wouldn't come? And the more they come, the more American health suffers--from such diseases as Chagas and TB, further cutbacks in hospital services to American citizens, and even possible closures.
Where's the compassion in that? Copper Queen ER nurse Josie Mincher, herself Hispanic, puts her health, and possibly her life, on the line to treat illegals. Listen to the emotion in her voice as she describes what that's like:
"I go to work every day feeling like I'm on a torture wrack. My heartstrings get pulled in one direction by these sick people I want to help. Because I'm Hispanic, I know how they live. And I'm pulled in the other direction, too, thinking that if our hospitals aren't around, where do I take my own kids?
"But we have to treat them because of EMTALA. It says that anybody who comes within 250 yards of an ER gets treatment. What would happen to Safeway if the law said anyone who comes within 250 yards of the store gets free food? They'd go out of business. Well, we're a business, too."
Mincher's solution? "Send the bills to Mexico. If it affected them financially, they might do something about all these people coming across. My grandparents came here legally, and it took a long time and a lot of money. They respected the law. These people just walk across now. They weren't brought up the same way."
Burns at UMC says he wants the U.S. and Mexican governments to work together to find a solution. But, as Kyl cautions, don't expect any breakthrough soon. Mexico benefits far too much from our illegal immigration nightmare--in jobs for its citizens and cash sent home--to step up with money to care for its own people. Until the border brought under control and the invasion stopped, we'll continue to pay the bills of people who illegally tiptoed across the line in the dead of night.
Guess the lefty loonies want disease diversity.
I say treat 'em & send the bill to the Mexican gov't. Once a year the unpaid balance is deducted from any foreign aid payments. So there - call your elected officials!
sorry about the double post, pull it if you wish
Why in the world can't President Bush see the necessity for closing the borders? I think he's a near-great president, but this failure is almost bad enough to cancel out the impact of his successes in Iraq and Afghanistan. If he'd turn this around, I'd rank him right up there with Washington and Reagan.
How about we start by imposing a "fee" on the money transfers from the U.S. to Mexico? That would strike at the heart of how Mexico benefits from exporting her people here.
You know, for something that I think you wrote partly in jest.....It's a BRILLANT friggin' idea. nicely done
I'm in favor of Hillarycare for illegal immigrants. Make companies provide free health care for all of their illegals.
ERs far from the border are crowded with citizens who are learning that ERs are 7/24 free medical clinics.
If the government mandated that all pizzerias deliver pizzas to anyone who called asking for them, regardless of their ability to pay, do you still think you'd get thirty minute delivery?
This solution would do two things. First, it might bring some money back into the healthcare systems that have been hurt by having to provide for the illegal aliens. Secondly, it might cause some of those who are hiring illegal aliens to realize that it is better to pay the cost of hiring American workers than to risk losing everything in one of these suits. If people didn't hire illegal aliens, fewer of them would come here.
It's not that he can't. He won't. "Guest Workers" are cheap labor.
Please don't insult the legacy of Reagan by comparing him to Bush. Bush is a socialist. He's what you get when your other choice is John Kerry.
There was absolutely no jest about it, I'm dead serious. These people are gonna bankrupt our country if we don't "get it" pretty soon.
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