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Posted by on Sep 27, 2009 in Economy, Health, Politics | 27 comments

Why Not Let Foreignors and Aliens Buy Into Health Insurance?

Despite all the dysfunctional attributes of the U.S. healthcare and health insurance industries, we do provide some people with the world’s best medical care as a result of cutting-edge technology and procedures provided by the world’s most talented physicians at some of our top institutions.

People with real life-threatening diseases come from around the world to many American medical centers to get care not available anywhere else. Some Americans also shop and travel internationally for elective surgeries that can be performed equally as well overseas but at a fraction of the U.S. cost.

Now this top level of care is rationed by price and ability to pay so many poor and uninsured Americans cannot afford even basic healthcare leading to many preventable deaths and bankruptcies in the U.S. However, the rancid debate about not permitting illegal aliens to obtain or buy into our healthcare system seems ludicrous and illogical from many perspectives.

From a moral and ethical standpoint, any “person” (under the 14th Amendment to the U.S. Constitution) has certain inalienable rights. All religious belief systems and secular ethics tell us that we must treat every human being with some level of decency and respect. We really cannot check out birth certificates and residency documentations when people are in accidents or emergencies before we render assistance. Anyone who argues the contrary is a morally and ethically bankrupt.

If an illegal alien or just a legal visitor from another country gets sick, that person might infect many other people, including U.S. citizens, if left untreated. Again, from a purely selfish viewpoint, most sane Americans would demand that person be treated to protect the rest of us.

From a purely financial perspective, the more people we have paying into a health insurance system, the better for everyone else within that same system. Premiums paid by those insured must equal payments made to provide for the financial sustainability of the system over the long term. Every rationale actuary would suggest that more healthy people paying into the system permits lower overall premiums. If we want to compel those who could pay but choose not to (i.e. the young healthy invincibles) why not let more healthy people who might not even be citizens pay into the overall system?

Whether there is a public option or not, any person on the planet should be able to buy U.S. health insurance. Perhaps the subsidies to buy into public or private plans would only be provided to U.S. Citizens and legal U.S. residents. If a person who does not fit those two categories and whether residing inside or outside the U.S., if a non-U.S. citizen wants to buy into a public plan or a private plan, why not permit them? If they must resort to emergency care, we all pay for it through higher premiums if they have no insurance.

Alternatively, why not let every American or non-American buy into Medicare? If the long-standing ratio of insurance coverage holds true (that 80% of the group pays for the 20% who actually need the care) then why not increase the size of the contributing healthy group so premiums could go down for everyone who pays into the system? Wouldn’t more foreign visitors to the U.S. for healthcare services benefit our entire economy and employment rate?

If Congress does preserve a nationwide public option, it may be a worthwhile offset to permit all private health insurance companies to operate in all states under national regulations. In this way, both the public and private insurance carriers could compete nationally on a level playing field.

It would also be fair to all individuals that any person, whether employed or self-employed could purchase insurance on the new exchanges. We should encourage slowly moving away from employer-based health insurance towards greater personal choice and to make our American businesses more competitive globally with foreign companies not saddled with such costs.

States should also be able to run some part of the public option as part of their Medicaid program so as to encourage ways of finding new cost savings and experimenting with better means of providing healthcare services. Medicaid should have national eligibility standards that are the same for people in all states, i.e. all households under 200% of the Federal Poverty Rate would be covered nationwide.

To answer some savvy critics who argue that current Medicare recipients see little benefits in healthcare reform so support is minimal from them, a few new benefits should be added to the current program to get their support of the overall reforms. Currently Medicare does not cover regular dental and vision care – two important needs of most elderly people. Instead of just covering emergency care in extreme situations, Medicare should provide at least one regular dental and one vision visit per year, plus cover some itemized procedures and equipment. Most elderly people do not have the extra income to pay for such needed ongoing care and small problems frequently grow until major and expensive emergency expenditures are incurred and paid by Medicare.

Medicare should be expanded to cover anyone over the age of 60 since private health insurance carriers do not view this group as a very good risk and only offer very expensive and limited coverage. Employers with group plans may see some savings if their older workers are transferred to Medicare as well.

Realistically speaking, the Federal government may have to assume more of the costs of Medicaid as this recent deep recession has greatly stressed all state budgets in trying to meet their share of Medicaid while maintaining other public programs amid falling tax receipts. States governments may convince some of their representatives in the Federal Government that they need such permanent financial assistance as most state budgets are predicted to be in the red for several years to come.

Critics of healthcare reform and any public option and mandates to buy insurance are now threatening to sue in state and federal courts arguing that compelling people to buy health insurance is unconstitutional, so as to defeat the economic underpinnings of all healthcare reform. Even though they did not bring up this argument earlier, now that some healthcare reform seems imminent, they are changing their philosophies and tactics.

States require minimum liability auto insurance, but on the basis that any government can compel the carrying of insurance for all sorts of human activities in order to obtain federal assistance.

Governments require homeowners to buy certain flood and disaster insurance depending upon where they live. States could compel drivers to get uninsured or underinsured minimum coverage and that would constitute insuring yourself in case a person without insurance or insufficient insurance hit you and your injuries and damages were not covered.

If health insurance purchase requirements were struck down, what would happen to other governmental mandates with respect to paying any taxes, meeting Medicaid eligibility requirements, complying with zoning, healthcare and building codes, enforcing non-smoking zones, and getting flood insurance?

Finally, the unreliable estimates of the Congressional Budget Office should be ignored for the first step in this legislation. Independent research has shown that the CBO has been pretty wrong about future projections on many prior pieces of past legislation. It underestimated the money needed for financial bailouts and greatly overestimated President Bush’s Medicare Part D Drug Plan costs, even though the plan does add significantly to the overall budget. While any competent mathematician, economist and accountant can use a variety of financial programs to project income and expenses far into the future, the assumptions and variables assumed at the beginning determine those numbers.

Unfortunately we humans have been proven quite wrong on most occasions when making assumptions about the future – even when just trying to extrapolate just a year or two out.

How many of us saw this complete economic meltdown coming back in 2006? Things change constantly and we should seek better and quicker mechanisms to adapt to normal changes.

We equally cannot constrain our national policy-making based upon inadequate CBO estimates.

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Copyright 2009 The Moderate Voice
  • Silhouette

    Is this the post where we’re supposed to say “Yes! That would be a great idea” and then the GOP crosslinks this thread like a billion times and runs with it saying the evil left wants healthcare for aliens?

    Look. Private insurance can do as it pleases. Public insurance is for american citizens ONLY. Got it?

    • rachelmap

      By your logic, I–a legally employed registered alien in South Korea–would not be able to buy insurance though my employer* in the country where I live and earn my money.Neither would any of hundreds of thousands of the other American expats throughout the world. Thanks a lot.

      *This is not private insurance that I have; it’s mandated and run by the government. There is also private insurance in Korea. If I want, I can also sign up for that on top of what I have now.

    • Gegenschattenbild

      No, I don’t get it. Why would you exclude legal alien residents–especially those who are employed– from a public service to which they are contributing by paying taxes?

      • The fear among the right about brown people getting any “benefits” is truly dysfunctional and irrational. Everyone seems to admit that we collectively pay the cost of health care when the uninsured end up in the ER. How about we grow up and admit that we’d be better off if EVERYONE’S care is delivered at the lowest cost, which clearly is not the ER.

  • Leonidas

    I actually do not have a problem with foreigners purchasing healthcare, so long as their investment covers the cost. I am against subsidizing healthcare for foreigners with taxpayer money. I think thats reasonable.

    • Leonidas — It seems that you are advocating that foreigners be allowed to buy insurance as long as they don’t use it? I do also think it’s reasonable that they don’t get subsidies, though.

  • Hi Marc — In general, I think this is an excellent article, and something that a lot of people — including progressives — have been unwilling to discuss.

    Only one small quibble: I do disagree with the idea of allowing cross-state purchase of insurance, but only on a practical level. I fear that we’ll get a “Walmart effect”, where smaller insurance players get pushed out of the market due to larger players (like we’ve seen in states like Alabama); this could be done by offering large discounts to the largest purchasers (large company plans), and then leaving individuals with no options.

    • Rambie

      I don’t like fencing in insurance companies into one state, we don’t do that the car/home/fire insurance companies do we? What other businesses do we fence into state lines?

      • Rambie, this is a states rights issue. Since the *practice* of health care is regulated by the states, they also have the right to regulate payment for health care. Some states require certain types of coverage to be in any policy, perhaps because they know they’ll be footing the bill if insurance doesn’t. Federal overruling of states’ rights to regulate is problematic, to say the least. As for your question (perhaps rhetorical) about what other businesses have state regulation, there are many. For example, in California all foods that contain carcinogens or mutagens must declare that. No other state requires this, but food companies have to obey it. So national food companies, or multinational for that matter, must have a California label unless they choose to label carcinogens nationwide (they don’t). In the same way, Wellpoint has to have a California program to meet state law (and Ohio or Texas, etc)

        • Leonidas

          this is a states rights issue. Since the *practice* of health care is regulated by the states, they also have the right to regulate payment for health care

          Thats actually a good point, and I’m inclined to agree. Doing it at the State level makes sense.

  • Leonidas

    Leonidas — It seems that you are advocating that foreigners be allowed to buy insurance as long as they don’t use it? I do also think it’s reasonable that they don’t get subsidies, though.

    I think you misuderstood what I was saying by the first part of your comment, let me try to clarify.

    I’m saying foreigners should be allowed to buy coverage just not subsudized via direct payment or if the system is paying below the cost. For example assume for whatever reason on average medicare is reimburing doctors at 91% of their costs. What I am saying is in the case of foreigners that they should be reasonsible for that additional 9%, not denied the 91%. That is not on an individual basis, just on the average. Another way to go about it would be to charge a 9% premium to foreigners if the average was shown to be 91%. If the program was paying 100% cost to doctors or more then there would be no such charge. I hope that clarifies.

  • tidbits

    This is a well thought out article. I agree with all except the mandates issue. In particular, allowing undocumented aliens to buy into health insurance makes a world of sense financially in adding to the actuarial pool and has the added benefit of being a morally defensible position.

    Providing undocumenteds with subsidized health insurance is a stickier issue. My gut reaction is that subsidies should be for citizens only, but two things make me want to think further: First we will pay anyway for anyone treated in an ER or Clinic either through subsidy of the facility or cost add-ons. Second, the moral issue bothers me in terms of denying health care based on country of origin. Just need to think about it more…no position yet.

    Aside. It’s interesting to see the cross section of agreement among the commenters on at least the issue of buy-in for undocumenteds, though other differences and nuances remain.

  • DdW

    Great to see you back, Marc. And thanks for a great post with which I agree 98%.

    However, considering the infinitely much more serious disagreements we have with our friends on the right on these issues, not even worth mentioning.


  • adelinesdad

    Who is arguing that illegal aliens shouldn’t be allowed to buy health insurance? I’ve been a little detached from politics for the past few weeks (on purpose), but unless something has changed, the argument is whether they should be eligible for government subsidies, and whether there should be any enforcement to ensure they are not receiving government subsidies.

  • adelinesdad

    “I don’t like fencing in insurance companies into one state, we don’t do that the car/home/fire insurance companies do we? What other businesses do we fence into state lines?”

    From what I understand, car and auto insurance companies are regulated at the state level. That doesn’t prohibit them from operating across state lines (and neither are health insurance companies prohibited) but then they may have to provide separate programs to satisfy the various requirements of the states.

    I actually disagree with many conservatives that the solution to our problems is to allow the federal government to supersede state regulation. That seems to go against state’s rights which actually is an important part of conservatism, at least constitutional conservatism.

  • What if we simply bill the national healthcare programs for countries that have them – like Mexico, Canada, the UK, France, Germany…

  • archangel

    Nice to see you back Marc. Keep on.


  • Paul Carter

    “If Congress does preserve a nationwide public option, it may be a worthwhile offset to permit all private health insurance companies to operate in all states under national regulations. In this way, both the public and private insurance carriers could compete nationally on a level playing field.”

    Why on earth would I want a level playing field for public and private insurance carriers? I want the best healthcare, not health insurance, for the least cost. If the government can do that, then they should do it. If non-profits can do it, then I want non-profits. If for profit companies can do it, then I want for profit companies. We were told back in the 1980s that for profit health insurance would provide better healthcare at lower costs because the market place is just better than the mainly non-profit providers that dominated healthcare insurance. This experiment has been an absolute failure at fulfilling that promise. Successful countries like successful people discard failure and adopt things that work.

    The first thing to remember is that insurance companies do not provide any healthcare. All they do is act as the middleman between doctors and hospitals (supply) who actually provide healthcare and the public (demand) who use and pay for healthcare services. This middle man function provides very little value added to the quality and cost effectiveness of the actual healthcare received by the public. The fact of the matter is that insurance companies have a conflict of interest between their profits and the quality and cost effectiveness of actual healthcare provided the public.

    • “Successful countries like successful people discard failure and adopt things that work”

      Paul, that’s the quote of the day for me.

    • adelinesdad

      “Why on earth would I want a level playing field for public and private insurance carriers? I want the best healthcare, not health insurance, for the least cost. If the government can do that, then they should do it. If non-profits can do it, then I want non-profits. If for profit companies can do it, then I want for profit companies.”

      Then you would want all of those entities to compete fairly, right? If the government can only be cheaper by putting regulations on private companies, then that’s not really the plan you want, is it? If it is, then I ask why the government doesn’t provide bread and gas? Clearly it can do it for cheaper if it over-regulated the private businesses.

      • The government does not PROVIDE health care. We’re talking about insurance. The government currently provides insurance for floods and other disasters. It’s a successful program that no one complains about. “The government” is us. If we decide that it is to the benefit of our “tribe” to care for the health of our fellow tribe members, we do that. If we decide none of the tribe should starve to death, we create programs for that. In my opinion, which I’m sure you don’t share, we should stop medical bankruptcy in America, as it hurts us competitively, not to mention the moral issue of destroying families for something clearly out of their control. We should stop crippling our industries with health care costs, which our global competitors do not have. The insurance industry is clearly not “over regulated”. It has record profits, up almost 500% under Bush, pays exorbitant top salaries, their premiums are rising 5 times faster than wages and we ALL suffer from it, for the benefit of very few at the top.

        • adelinesdad

          I’m not sure what part of my comment you are responding to. Paul said, “Why on earth would I want a level playing field for public and private insurance carriers?” implying that he’s OK with the government having unfair advantages over the private sector. I just pointed out that that view is inconsistent with the view that we want to best healthcare possible and the lowest cost, whether it is public or private sector. Maybe I’m misunderstanding what he meant when he said “level playing field”. If he means to make the cost equal, I agree with him, but the common meaning of “level playing field” I’m familiar with is to let all players compete with the same rules, thus allowing the best player to win. If we want the best system, then I’d think we’d want a level playing field.

          • I did forget your first comment. I’m not for “subsidies” for “illegals” either. I’m for single payer (but if you’d rather the cost of ER visits be picked up by the privately insured than by everyone, well that’s still irrational assuming you have insurance). But with respect to private insurance and “level playing field” I disagree. We as a nation may wish to assure that our citizenry has access to health care at the best cost. The goal of private insurance is denial, not delivery, of health care payment. The LESS they deliver the more money they make. Actually paying claims is called “medical losses”. That is the exact opposite of what we pay them for, and it’s the opposite goal of governing for the public good. If they are at cross purposes with the goal of the public, they are the worst possible choice for delivery of health care compensation to our citizens.

  • adelinesdad

    “The fear among the right about brown people getting any “benefits” is truly dysfunctional and irrational.”

    Ah yes, I’m racist. Thanks for reminding me.

    Wouldn’t it be dysfunctional and irrational to tell people who want to come into our country to do so legally, and then reward those who come illegally with entitlements?

    • You’re welcome, though I wasn’t speaking of you specifically. However, whether or not you’re racist, if you prefer to spend big bucks on ER treatment rather than allowing potential *patients* to buy insurance, you truly are irrational. And if your argument is that we should let them die, well you’re heartless as well. Let’s face it, doctors won’t willingly let those who can’t pay die. Let’s find the most cost-effective way to cover the legitimate medical costs of our people, and yes, even those here illegally. Immigration reform is a separate issue. Your GOP team failed to address it. Frankly, it’s not high on my list of essential reforms, but health care is. BTW, I don’t argue these points for myself, anyway. By the time your insurance premium has doubled (9 years), I’ll be on Medicare. Good luck with your Blue Cross bill. If you think your employer will continue to pay that, you have a very nice employer. Or you’re deluded.

      • adelinesdad

        “if you prefer to spend big bucks on ER treatment rather than allowing potential *patients* to buy insurance, you truly are irrational. ”

        I don’t object to allowing anyone, including illegal aliens, to buy health insurance. I said so in my first comment. I object to creating a reward for breaking the law.

  • Dave Francis

    Our government panders to the 20 to 30 plus (?) illegal immigrants allowing them free subsidies from taxpayers in the US. California–a Sanctuary State has one of the worst records that currently languish under the immense burden of near bankruptcy, instead of –ATTRACTING–ICE to illegal business operations. Why wouldn’t certain legislators want health care for foreign labor, because they have an over abundance of illegal immigrant families to financially support? Our own government is so absorbed in protecting every other countries border? They remain unconcerned to our poor replica border fence that should have been a two-tier periphery, with border patrol surveillance lanes in between, as originally planned by Rep. Duncan Hunter. Every time a good enforcement plan is written, it’s methodically cut to pieces by pro-illegal worker politicians and open border fanatics. Though we spend billions on our armed forces in foreign lands, the rich countries in Europe just forward token troops and little money: while our nation is literary falling apart at the seams–or its rivets?

    Any moment now I expect to hear of yet another collapsing ailing city bridge, deteriorating waterworks, the underground pipes and eroding highway. Our cities are already exhibiting inward decay, but years of neglect by the very people who’s supposed to protect us do nothing? I have reiterated watch “The Crumbling of America” on the History (International) channel in the next few weeks and learn? This is where your tax dollars should be going? We must not allow the Administration as in previous times keep sending our precious tax dollars to other countries. These politicians are deaf, dumb and intentionally blind to the rigors our industrial nation is going through. Not just Democrats, but the Republicans have had their sticky fingers in the bad apple–SPECIAL INTEREST–barrel, where money is plentiful. It’s like they are intentionally trying to turn our magnificent country into a third world nation, while making other cheap labor countries, on an even par with our sovereign society as US wages tumble? Then Again the Council of Foreign Relations have been amplifying its agenda of free movement of cheap labor through North America for years?

    Most of these other lands have been at each others throats for centuries, so why do we expect any metamorphism into something any different? Only change can come from within, not by our nation expending billions of dollars, American lives? We must build our own borders fences, tall and strong and meant to keep out drug dealers, criminal aliens, terrorists and the never ending tracks of illegal aliens. Our politician’s noses are involved in too much foreign policy, while our aging infrastructure implodes. Trillions of dollars are spirited out the country, while we gain little in return. Washington–MUST–start giving back to the jobless American worker by placing a 5 year moratorium on all immigration, even legal? The next politicians should deliver us from any new sinister path to citizenship or better referred to as BLANKET AMNESTY? Follow the “Rule of Law” and not twist it into something else for their own convenience, as it will come back to haunt them at the voting booth. Unless ACORN steps-in with another fed contract and handles sign-ups for the ballot box? In that case will still see absentee ballots for the deceased people, pets and anybody who has learned that you need no government picture ID to sign on to vote.

    The 1986 immigration reform bill dismally failed last time and all we inherited was 5 million illegal immigrants that still keep on coming with their impoverished hands out. Anti-Illegal immigrant forces are growing in numbers to stop another travesty. They acknowledge it could end up costing billions, perhaps even trillions of dollars. Nationwide we have seen the advent of closing hospitals and emergency rooms that have been submerged everyday by swarms by penniless foreigners and their families. Yes! We need health care reform. Americans are dying, going bankrupt , falling under the spell of debt collectors. The special interest lobbyists are causing mass hysteria by lying to the people. Many insurance companies are under this bombardment in television, radio and mass media. Their Status quo wants no change to their profits or high flying CEO’s making millions of dollars. on patients backs? I want health care reform, for the sake of my step daughter who died of Cancer, because the insurers said it was a pre-existing condition and they couldn’t continue to insure her?

    It has become an enigma–THAT THE EMPLOYERS WHO HIRE THEM-LEAVE THE MAJORITY OF SICK PEOPLE ON THE STEPS OF EMERGENCY ROOMS. SO THAT THEIR RESPONSIBILITY ENDS THERE? THEY DRIVE AWAY WITH A CLEAR CONSCIOUS? THEN IS LEFT FOR THE TAXPAYERS CHECK BOOK TO PAY THE BILL? THOSE EMPLOYERS SHOULD BE HUNTED DOWN AND HELD ACCOUNTABLE FOR EVERY CENT. We have already been warned by the census bureau of overpopulation in the not too distant future. WE now have a very unique deterrent called E-Verify, that is a part of the SAVE ACT and our lawmakers should stop procrastinating and make it permanent for every worker? Washington knows their walking on quicksand, if the try to under fund or spirit away E-Verify this time around? The corrupting influences from the special interest lobby, have failed to induce many lawmakers to table E-Verify. In our future it could have many other uses other than extracting unauthorized labor from the workplace. Once fully installed it could check state drivers license applicants, insurance, school and higher education registrations and hospital admittances.

    Americans have been unknowingly paying taxes to underwrite subsidies for the illegal population for decades. This is the biggest draw to American jobs, because the employers who hire them are sentient that taxpayers will foot the bills for education, health food stamps, housing and other government benefit consignments that even as citizens are denied. Keep the phone calls coming at 202-224-3121 LOOK FOR ANSWERS AT NUMBERSUSA, JUDICIAL WATCH & OVERPOPULATION AT CAPSWEB? These websites can identity politicians who actually work for the American people and others whose immigration grading level is unsatisfactory to stay in office? Have you heard about any large ICE raids lately? ICE got the order to cease and desist from the motley Democratic leadership. They are also using their influence to either weaken the federal training program 287 G that gives local police federal right to hold for questioning suspicious individual’s immigration status and to rescind the no-match-letter capability in determining a person’s right to work?

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