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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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