Illegals and Health Care

I am really torn about this issue; illegal immigrants getting sick in the US. A Federal court in NY has indicated Medicaid funds cannot be used for non-residents (illegals, students and visitors) needing chemotherapy.

First, I am a physician and feel a strong moral obligation to help whomever I can. But I am also a tax-payer and know there are limits to what any society can afford.

Illegal immigration is a political issue and the reasons underlying it are complex, social and economic issues that have gone completely unaddressed by the ridiculous attempts at enforcement. There are individuals who are little more than visitors and have managed to outstay their welcome, despite the benefits they bring to the economy at large.

Once I am in clinic I cannot ask, nor care, about an individuals immigration status. It is unethical and immoral for any physician or health care provider to treat someone solely based on their nationality. Physcians are not even supposed to refuse to care for people who are criminals. If a mass murderer seeks care, as odious as it may feel, I have an obligation to treat the patient as long as there is no imminent threat to myself, my staff or the people in the building.

But where are the limits. Everyone has to get paid somewhere down the line. There is no longer enough margin in private practice or hospital operations to allow charity care for long, complicated and expensive treatments. Directly or indirectly, the states are left holding the bag for a bunch of unremunerated care.

The alternative is to let people die.

I remember one lady who split her time between South America and here, where her daughter had emigrated. Just before returning to the US, she had her mammogram (it was cheaper). A day before she got on the plane, she was told she had bad-looking lesion and probably had cancer. She came to see me in tears.

Without insurance and insufficient funds to cover the treatment, she was truly out of luck. In this state, she could never qualify for any public assistance. Her only options were a local charity or return to South America and do the best she could with what was available to her there.

As a physician, I want to get her the care she needs. That's it. No ifs ands or buts. Keep me out of enforcing a political agenda, even if I sometimes wonder where my tax money is going.