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November 28, 2007

Illegal Immigrants Don't Overuse Health Care

We've gone over this sort of thing before, but here's (yet another) study showing that illegal immigrants vastly underuse the health care system. Contrary to fears that they see seven hours in the emergency room as an awesome, cost-free night on the town, it turns out they're 50% less likely than U.S-born Latinos to use ERs, and that means they're almost certainly less likely than that to seek care elsewhere, as the ER is about the only place you can go if you lack insurance.

Meanwhile, it's worth pointing out that so long as we're going to have illegal immigrants in the country -- and, for now, we are -- we actually do want them to get health care. It's no harder to catch the flu from a day laborer than an investment banker. And, from a coldly economic standpoint, it's better to have productive workers than disabled, marginalized members of society spending their days limping into ERs for routine care.

November 28, 2007 | Permalink


Interestingly, I just caught a nasty cold from an investment banker.

Posted by: John | Nov 28, 2007 11:28:47 AM

I've never seen the argument framed that way. I don't recall ever once hearing someone complain that the average illegal visits an ER 1.7 times per year versus 2.4 by legal residents or whatever the actual number is. Who cares how mnay time per year, the complaint is they are using it in the first place. 1 or 1.5 billion is considerable money that could be used to pay for citizens.

Posted by: Nate O | Nov 28, 2007 12:10:16 PM

Nate O,

No doubt you would prefer that we not pay, as a society, for clean air or water for fear that illegal aliens would benefit from clean tap water? But in any event lets berak the issue down logically. Poor people without health insurance are forced to access emergency medical care when they are desperate--that's true across the board whether the poor person is an indigenous american citizen whose pedigree goes back three centuries or whether they are a recent illegal alien or a returned but homeless Iraq war vet. But remember--all of those people including the illegal alien may have paid taxes before. Being illegal doesn't mean you don't pay taxes, and begin a legal citizen doesn't mean you *did* pay taxes if you are poor enough or rich enough.

But in any event emergency medical care isn't a privilige--its a necessity forced on people because the conventional medical system consistently fails them. That's because medical care has to be delivered to be useful and we have a system in place that consistently denies people medical care for reasons having to do with the crazy crankiness of employer delivered health insurance. If I'm employed one day and paying my premiums why do I suddenly become uninsured and uninsurable when I lose that job? didn't I just pay all those premiums? And if I'm an illegal citizen paying taxes (all kinds of taxes, by the way, including cigarette taxes and sales taxes and possibly income taxes and etc....) why shouldn't I or my dependents access the govenrment services I'm paying for?

But in any event the point made in the original post is a valid one--epidemics and illness *cross borders*--all kinds of borders--from men to women, from race to race, from class to class, from legal to illegal and back again. Our fragmented, pay as you go, employer insurance driven medical system not only *underserves* the insured (whether legal or illegal citizens) but radically underperforms and underserves the country as a whole. In the event of a preventable pandemic we will be very sorry that we were penny wise and pound foolish.

Posted by: aimai | Nov 28, 2007 12:22:35 PM


Illegal Immigrants Don't Overuse Health Care

This seems to be knocking down a strawman argument. Who is saying illegal immigrants overuse health care?

Posted by: wisewon | Nov 28, 2007 12:27:11 PM

Illegal Immigrants Don't Overuse Health Care
This seems to be knocking down a strawman argument. Who is saying illegal immigrants overuse health care?
Posted by: wisewon | Nov 28, 2007 12:27:11 PM

Ever listen to wingnut talk radio for more than fifteen minutes?

Posted by: chowchowchow | Nov 28, 2007 12:40:38 PM

And just to pick a nit, you don't need health insurance to have access to flu shots. They're offered at all sorts of places, including local drugstores and supermarkets.

Posted by: lux | Nov 28, 2007 12:43:53 PM

To clarify:

Yes, conservatives talk about illegal immigrants using health care. But I haven't heard anyone talk about their overuse of health care, which was the point of this post.

Posted by: wisewon | Nov 28, 2007 1:00:44 PM

And here's another bonus to exploiting third world poverty...of course it all for the top .01%........

It's good to see Liberals [wealthy, "people who matter"] and conservative [wealthy, "people who matter"] agree on exploitation of third world poverty both here and abroad.

"...Greenspan blames economic globalization and its downward pressure on U.S. wages. Assessing the "conundrum" of what killed inflation, he points out that 500 million new workers in low-wage countries have been producing for export since 1989. "This movement of workers into the marketplace reduced world wages," Greenspan writes. He adds:

Even though the aggregate payroll of the newly repositioned workforce was only a fraction of that of developed nations, the impact was pronounced. Not only did low-priced imports displace production and hence workers in developed countries, but the competitive effect of the displaced workers seeking new jobs suppressed the wages of workers not directly in the line of fire of low-priced imports.

Take that, globalizers. What's the remedy? As a conservative ideologue, Greenspan is categorically opposed to any of the policy instruments that might restore a more balanced income distribution. He abhors regulation, disdains trade unions, much less labor standards in trade agreements, and opposes social spending. And he is far more worried about a backlash of "populist" politicians exploiting economic discontents and sowing protectionism than about the substantive problems of insecurity and inequality. Instead, he makes an entirely unconvincing pitch for better education, despite his acknowledgement that no amount of education will equilibrate U.S. and Third World wages."

Posted by: S Brennan | Nov 28, 2007 1:02:44 PM

Bob Marshall, a Virginia State Delegate says on his official state webpage that illegals cause problems in ERs due to overuse.

Over at Cafe Hayek, Bob Boudreaux accepts fully the argument that illegals overuse government services of all kinds, though I do admit he doesn't provide any evidentiary support. However, Cafe Hayek is of course a wingnut wonderland, so if anyone would know what the common arguments from the right are, it would be them.

Let's see, there's this column from the San Francisco Chronicle, of all places, that has this delightful paragraph:

Illegal immigrants badly overuse ERs instead of tapping into often-free health-care clinics or finding a family doctor. Their behavior cries out for reform, not encouragement. California should spend dough to educate immigrant families to stop using costly ERs as a replacement for the family doctor. Again, we are not supposed to talk like this. But if the misuse of the ER system ended, we'd quickly discover that taxpayers are pouring more than enough into California ER care, and people with true emergencies would be far better served.

The idea that illegal immigrants are the primary cause of our healthcare woes is very popular because it combines the right-wing desire to claim that our healthcare system is fundamentally sound while piling more blame for our problems on illegal immigrants.

It's ridiculously easy to document.

Posted by: Stephen | Nov 28, 2007 1:32:22 PM

wisewon has a point: that's to say, many wingnuts don't differentiate between 'overuse' and 'use', since any use is too much.

Amputated a finger in the slaughterhouse to give Limbaugh and co. the cheap steaks that they consider their right as citizens? Bleed the fuck to death.

Posted by: pseudonymous in nc | Nov 28, 2007 1:47:17 PM

"Instead, he makes an entirely unconvincing pitch for better education"

What kind of better education, Mr. Greenspan? Spend 4+ years in college to get an IT job and it's already outsourced by the time you graduate. Accounting, radiology and many other fields requiring "better" education are moving offshore, too.
Maybe we should be encouraging students to look at good-paying jobs that are hard to outsource - plumbers, electricians, auto repair - that don't require graduate degrees and mountains of student debt.

Posted by: CParis | Nov 28, 2007 2:00:29 PM

Just some of the issues with this "study" - and the Reuters "reporting" on it - are listed here.

As far as that "coldly economic standpoint", illegal immigration is so clear an indicator of massive GovernmentCorruption that I'm sure that even Ezra Klein could - with others helping him - see it. If those others help him think it through, I'm sure he can see the economic impact corruption has.

Posted by: TLB | Nov 28, 2007 2:16:26 PM

with others helping him

Are ad rates at MexicansScareMeMommy.com slipping that badly, Kelly?

Posted by: pseudonymous in nc | Nov 28, 2007 2:29:50 PM

CParis and S Brennan in one interview about his book I saw Greenspan recommend allowing more professionals to immigrate in order to narrow the income gap.

Posted by: Floccina | Nov 28, 2007 2:43:36 PM

"and just to pick a nit, you don't need health insurance to get a flu shot...they are offered all over the place."

a) flu shots are not "offered all over the place" unless you are talking about fairly late in a mild flu season when the government bought flu shots are going begging. Its ridiculously hard to get flu shots unless you are registered with your doctor as one of the vulnerable populations. But even if you *could* easily get flu shots even if you were an illegal alien so what, flu isn't by any means the only pandemic we could/should be worrying about.

Here are just a few things that having no serious national health care makes prevalent when they don't have to be:
chlamydia (and infertility).
cervical cancer
untreated breast cancer
untreated diabetes
untreated tb
anthrax and other bioterrorist threats (I worked on this so I know that we have simply no way of early detecting and dealing with any bioterrorist threat)

Some of these are spread from person to person and some aren't but are quite serious. A comprehensive national health care system with free and easily accessed clinics would help stop easily transmitted diseases in their tracks.


Posted by: aimai | Nov 28, 2007 2:46:54 PM

Nate is correct.

The complaint is that illegal aliens use services. On the other side of the coin, the complaint is also that employers are not held to the law for knowingly hiring them.

Solution: Crack down on employers who knowing hire illegal aliens. Also, deport known illegal aliens. This would solve most of the problem.

For those on the left, it's known as enforcing the law.

Posted by: El viajero | Nov 28, 2007 3:43:45 PM

el, nate isn't "correct" he simply states *an opinion* which is, oddly enough, not shared by other people.

I know you and nate think that the immigration status of a person should determine every bit of treatment they get in the universe--from whether they are accorded civil rights to whether they are accorded human rights and, apparently, to whether they are accorded humane treatment in an emergency room but *everyone in the world* doesn't agree. See, people don't give up their human rights when they cross a border, or when they are undocumented, or when they are "illegal" in some sense. For example--things you can't do to an illegal alien? You can't murder them. The reason why is that they *didn't lose the right to life* when they crossed the border into another country *even if they did it illegally*. Now apply this logic to other things. You can't starve them to death, or beat them, or deprive them of pay for work they have performed, or defraud them and as a society we might *even choose to care for them if they are sick.* Its a choice we might make. Nate happens to think otherwise but he is neither "correct" nor "incorrect" he is just sharing his (rather ill informed and ill thought out) opinions.



Posted by: aimai | Nov 28, 2007 4:09:14 PM

As usual (make that: as always) aimai doesn't have a clue what she's talking about. It is easy to get a flu shot in the United States. Even grocery stores offer them for a nominal fee.

More importantly, there is absolutely no empirical basis for the claim that providing illegal immigrants with free health care services would save more money than it costs. This is yet another example of liberal wishful thinking presented as fact.

Posted by: JasonR | Nov 28, 2007 4:26:51 PM

It doesn't cost whoever ends up paying less for someone to go a doctor's office than to an ER, JasonR?

Posted by: witless chum | Nov 28, 2007 4:37:17 PM

Depends on what they're going for, witless. I'm not sure why you think your question is relevant, anyway. If you think you have evidence showing that we'd save more than we spend by providing free health care to illegal immigrants, I'd love to see it. I doubt we'd save money even by providing the most cost-effective health care interventions for free, like vaccines and antibiotics, let alone expensive high-tech health care services like CAT scans and surgeries.

Posted by: JasonR | Nov 28, 2007 5:08:57 PM

I know you and nate think that the immigration status of a person should determine every bit of treatment they get in the universe...

Immigration status certainly should determine if the public coffers are to be used to provide benefits. According to you, there should be no special status to being a citizen.
Hey, if you feel that it really doesn't matter if they are citizens or not, why not start providing healthcare and other benefits for other non-citizens in neighboring countries? I'm sure Mexico has some poor that you might want to provide WIC payments or even medicaid. It's so unfair that simply because they are the ones that didn't illegally cross into the US, they don't get healthcare. Then, of course, there's The Sudan.

Posted by: El viajero | Nov 28, 2007 6:01:41 PM

Immigration status certainly should determine if the public coffers are to be used to provide benefits.

But in the case of treating communicable diseases there is a direct and obvious public benefit to the expenditure of public dollars to treat illegal immigrants. Shall we stop building roads because illegal aliens also benefit from them? Your position is a textbook example of cutting off your nose to spite your face.

Posted by: DMonteith | Nov 28, 2007 7:20:12 PM

Jason misstates the discussion, as always. No one says it would *save money* to offer health care to *anyone.* It might save us *mass pandemics* and it would certainly prevent everyday *epidemics* but it would cost a lot of money. The costs to our society of failing to stop a mass bioterrorism attack will be huge. The costs of protecting us from such an attack will also be huge. Interestingly enough putting in place the extensive networks of health care necessary to identifying and isolating contaminated individuals and areas will also result in benefits to society as a whole *even though they are expensive*. As others have pointed out above you can catch a lot of nasty diseases from people who are physically close to you *even if there is a lot of social distance from you.* Dishwasher's and line cooks, hairdressers and nail girls, home health care workers, lunch ladies etc... *all come into contact with all of us* regardless of their legal or illegal status. Working towards making sure that people get the health care they need so they can live and work cleanly in our society makes good sense as well as making for good living conditions for all of us. But it will be expensive.

This whole discussion reminds me of that wonderful slogan: think education is expensive? Try ignorance. I take it that el viajero and his friends have interpreted that the wrong way and are manfully trying ignorance.


Posted by: aimai | Nov 28, 2007 7:24:32 PM

aimai is wrong yet again, as she always is.

No one says it would *save money* to offer health care to *anyone.* It might save us *mass pandemics*

Any number of policies might prevent "mass pandemics." That doesn't mean any of them are good policies, let alone cost-effective ones. There's no credible empirical argument for "universal health care" on the grounds that it "might" prevent a "mass pandemic" (or even merely an "epidemic.")

As others have pointed out above you can catch a lot of nasty diseases from people who are physically close to you *even if there is a lot of social distance from you.*

You really don't have a clue what you're talking about. The risk of catching a "nasty disease" in the U.S. from casual contact or physical proximity to a person who lacks health insurance is utterly minuscule. And providing everyone with health insurance would do essentially nothing to reduce that already-tiny risk.

And if infectious disease were to become a serious health problem in the U.S., the proper response would be the standard public health measures used in such circumstances: mass vaccination or treatment, isolation, quarantine, etc. It doesn't take "universal health care" to protect a child from polio, it takes a $10 vaccination. And since the last case of polio infection in the U.S. occurred almost 30 years ago, even unvaccinated individuals are at virtually no risk at all of contracting the disease.

Posted by: JasonR | Nov 28, 2007 7:49:10 PM


But in the case of treating communicable diseases there is a direct and obvious public benefit to the expenditure of public dollars to treat illegal immigrants.

Depends on the severity and prevalence of the disease. If there were an outbreak of a serious infectious disease in an illegal immigrant community, or a serious risk of such an outbreak arose, it might be cost-effective to spend some money on vaccinations and drug treatments targetting the particular community and the particular disease in question. That's a standard public health measure. But providing all illegal immigrants with general health care services is a different matter entirely. That would be an enormously cost-INeffective way of addressing the risk of infectious disease, because the vast majority of interventions provided by general health care services would do virtually nothing to reduce that risk.

Posted by: JasonR | Nov 28, 2007 8:02:59 PM

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