Obamacare and Illegal Aliens

I realize the Healthcare Reform Act has been very controversial. Some love it, some hate it, some support the idea but feel it needs revision. It is certainly being brought up a lot in the current campaign year. People have the right to their own opinion, but what really irks me is the constant misrepresentations of what the bill actually says. Political ads constantly bombard the public with half truths and sometimes outright lies to sway the public towards their candidate. Since so many people make their decision on those ads alone, and not on the reality of the candidate's true record or principles, I wanted to throw in my two cents on a few points as an example of how the truth can be distorted.



First thing, is I do want to make comment on the journalistic abilities of Fox News. It is not just because Glenn Beck is on my top ten list of men in the world most deserving of a thorough ass whooping, but I have issues with the station as a whole. Fox News was bought by noted conservative newspaper man, Rupert Murdoch solely for the purpose of pushing a hard core right wing agenda. They have no interest in the truth or providing non-biased information and often broadcast information that is blatant lies. If one is looking for the most objective reporting available, The Christian Science Monitor has long been noted for this, surprisingly enough. Even Oscar the Grouch's grouchy girlfriend on Sesame Street said she was going to watch Fox News because "now that's some really trashy news." I played that over numerous times on the TiVo to make sure what I was hearing was correct, and yes, the writers at Sesame Street went that far out on a limb. They helped to propagate the whole "death committee" rumor which never existed to begin. If done in error this shows the signs of very incompetent journalism. If done on purpose it is apparent this was reported with a great deal of intent of malice. The rumor initially propagated by a republican politician whose name escapes me put forth the statement that Medicare recipients would be required at regular intervals to meet with a committee to discuss their plans on how they intend to shorten their lives and prevent unnecessary medical expenses. There was never anything close to this proposed, but when Fox News and Sara Palin got word of this work she wrote to the story and ran with it. What really was suggested was to offer Medicare recipients "end of life" counselling, but it was never mandated. End of life counselling addresses issues such as designating a power of attorney, writing a living will or advance directive, etc. These are issues that do need to be addressed, and probably long before someone reaches the age where one can qualify for Medicare. Many families and providers have been put in a quandry when an incompetent patient without a power of attorney demands to return to an unsafe situation. Most famillies do not have the thousands of dollars needed to hire an attorney to start the process to declare a family member incompetent. Either way the process takes weeks, forcing providers to send these patients home. Many patients die as a result. Having a designated power of attorney to speak for the patient may result in the patient placed in a safer setting. In the long run, this could end up costing the system more, not less as implied by the "death committee" principal. I am not sure if the end of life counselling was dropped from the final product but do believe people are often too quick to act and make assumptions about something without really reading what the clause actually says. This type of behavior can have dangerous consequences in the long run.


My biggest area of contention is the constant barrage of political ads that distort that truth of a given candidate's opponent by taking certain clauses out context and twisting them to mean something completely different than the truth. I have seen far too many ads recently that stated that supporters of the Health Care Reform Act are giving out millions of dollars in health care to illegal aliens. Much of this stemmed from the initial version that did not have a clause in it that specifically stated that illegal aliens (or undocumented persons, or whatever term is the term du jour) were to be excluded in this plan. It did not state that illegal aliens were to be included in the plan either. It is very easy to take the phrasing of the act out of context and state that supporters of the bill are throwing dollars at illegal aliens for health care. That does not make it true.


I work in a setting where a large percentage of our patients are uninsured and have lived in area of the country that played host to large populations of migrant workers at certain times of the year. Tuberculosis runs rampant in these populations as does diabetes. Dental problems are a huge issue. HIV and syphilis are an increasing problems. With the exception of dental caries, these are communicable diseases that could get passed on to American citizens. But they are not monsters, they are humans, and yes, they too need medical care sometimes. These people do not receive health insurance from their employers. The American people need to stop bickering about who is giving money to illegal aliens for health care and who is not and face the fact-


We always have covered the cost of healthcare for illegal aliens, we continue to cover the cost of their care and as long as they are living in this country we always will. These people simply do not crawl in a hole and die when they get diabetes, they go to the ER. They do the same for TB, pneumonia of any other malady they suffer from. There are some areas where clinics have been set up to address their health problems but for a large percentage of them, they end up as high end utilizers going to the most expensive place possible to receive health care because it is the only place they can go when they do not have the money to pay for their care- the ER. Federal law forbids hospital ER's from turning patients away just because they do not have insurance. If they need inpatient care and there is a bed available the hospital must admit the patient or the hospital faces some hefty penalties. If there are no beds, the hospital pays at its own expense to send the patient to the nearest hospital that does have a bed. That law applies to every patient who walks in the hospital doors, citizen or not. Even without those laws, the Hippocratic oath does not only apply in cases of resident aliens and citizens and any physician who refuses to care for a patient because that patient is an illegal alien should have his license revoked.

Of course, the other issue is that doctors never walk into the exam room with the patient and start out the interview with "So Mrs S, are you an illegal alien?" I have never asked a patient of mine if he/she was an illegal alien and would put down good money nor has the vast majority of the practicing physicians out there. We do not know, we do not care. We do not treat "Green Cards". We treat people.

So who pays all those ER bills? You do. Personally, I would rather pay for a $40 office visit to a family doctor but that would be "throwing millions to pay for medical care for illegal aliens." Those that oppose the Health Care Reform Act may have a lot of good reasons to be opposed to it. There are a lot of stipulations that are not popular and some things that may not be the best option for the nation. Not wanting to pay for medical care of illegal aliens is not a good one. Repealing the Health Care Act would result in the taxpayer covering a $600 ER bill rather than a $40 clinic bill. Why? Is it because one does not want it "on the books" that illegal aliens can access health care. Doctors and hospitals are still going to treat our patients, whether they are illegal aliens or not. We have an ethical duty to do so and a federal statute (EMTALA Act) that requires it. Let the Tea Party say what they will. We would still be paying for health care for illegal aliens, just a WHOLE lot more.

Health care reform

Well, we may, or may not have some kind of health care reform passed in Congress now that may or may not be amended to death in the next few months, but hopefully we will have some kind of change for the better. I have nothing witty or interesting to say, but I can say that we have had a lot of patients being admitted recently who have Medicare and have hit the "doughnut hole" already and are falling apart because many of the generic medications available in psychiatry are in no way related to the newer, name brand ones. Even some of the second generation medications that have come out in generic are still running in the several hundred dollar range a month. Somehow I do not see that the prescription drug benefit program for seniors and the disabled has done what it is supposed to and it does not make a lot of fiscal sense. Sure, Seroquel can run around $1000 a month, but a patient who decompensated and ends up on the psych unit for seven days costs the taxpayer $7000. I would not worry about us having enough patients to keep us busy on the psych units. The drug dealers will always make more. This reform bill is supposed to closed the so-called doughnut hole, but it is going to take years, and I fear that partisan bickering is going to whittle the bill into some worthless piece of bureaucratic nonsense and the Medicare patients will fall by the wayside. I hope for the best. My patients do not have much time to wait.

Thank God for Generics- part II

Returning to the issue of money buying happiness, and the endless debate about health care reform, the lines between money and happiness get blurred in this arena. It takes money to have health care, and it takes money to buy health insurance. I can think of a lot of situations where lack of money and, therefore, health insurance would have guaranteed certain suffering. The mere existence of health insurance brought a great deal of happiness into a person's life. Most people can probably think of a case in their own life of a friend or family member struck with a life threatening illness that would not have survived without treatment. Most people do not stop to think about the cost until they are faced with the bill and no way to pay for it.

In my own life, the happiest thing that ever happened to me came at a very great expense. It is very easy to criticize the enormous cost of Neonatal Intensive Care Unit (NICU) care until one becomes the parent of a child who is a patient in one. After that, there is no test, procedure or intervention that is too expensive if it was needed to help ensure one's own child's survival. I faced this situation four years ago, quite unexpectedly one winter day while eating lunch at work. Without warning, at 34 weeks pregnant, I felt my amniotic fluid leaking. Up to that date, everything had gone perfect, no problems, complications, the baby's size was good and I felt great. I did not smoke, drink, do drugs or abuse my body. I ate well, took care of myself, had good prenatal care, a supportive husband and so on. My only sin was advanced maternal age but no one else seemed too worried about this so neither did I. Until that day.

The series of events that followed were somewhat of a blur with a lot of panicked phone calls to my husband at work, a trip to the obstetrician and hospital and the eventual comedy of errors that lead to the birth of a somewhat distressed boy who was healthy for his age and able to breathe on his own, thankfully. He spent the next 31 days in the NICU and my husband and I spent our days going between our home and the NICU several times a day to visit him. I even returned to work part time so not as to burn up all of my maternity leave. I would dutifully see patients for two hours then hiking down the block to nurse him and return to see more patients. Neither one of us thought we could endure but one of the other NICU parents told us "you get used to it" and he was right. Eventually we learned the routine enough to endure until the magical day when he was finally released to go home. He wore oxygen by nasal cannula for several months and an apnea monitor for several more. The oxygen tanker that came every two weeks to fill up the big silver missile in our living room did tend to attract some odd looks in the neighborhood and it was hard enough being inexperienced parents without family nearby to help us learn how to care for a newborn as it was. We certainly could do without the hindrance of a 30 foot tube that he had to be kept tethered to 24 hours a day, but somehow we endured.

Today, our son is a perfectly healthy four year old who knows how to read quite a few words, asks questions like "how do Ipods work?", and loves to go to Preschool and swimming classes. No one would ever know how rocky his start to life was unless we told them. For all the torment we went through, I would do it all again to have a healthy child now. I was lucky enough to have health insurance to cover most of the bills, although I still had around $5000 out of pocket expenses to pay. Not a problem for a doctor, but the cleaning staff working at minimum wage might have a tough time stomaching this kind of bill. Imagine life for those without insurance. For those who do not want health care reform, think about those people and their children before rejecting the idea entirely.

In summary:

The total bill for the NICU alone: about $75,000.

The cost of the RSV vaccine he received every month for several months after discharge: $1600 per injection.

Apnea monitor:$350 per month rental fee.

Home oxygen and equipment:Your guess is as good as mind.

Having a healthy, happy child:Priceless.