Keep Kids Covered -- Especially Immigrants

A couple of weeks ago, an article in the LA Times about young immigrant liver-transplant survivors who hit 21 and lose state health coverage which often causes a lapse in their post-transplant care without chances for re-transplantation, should have caused more of a (political) stir than it did. Not only did it shine a light on whether or not young, illegal immigrants should receive taxpayer-supported medical treatment; it broached an issue powerful enough to illuminate a candidate's sheer humanity, regardless of his or her opinion on immigration reform, and it should have been discussed in one of our pointless debates.

In reporter Anna Gorman's story, a young woman circumvented near-certain death and won her way back to state-supported care at UCLA, which could offer her another transplant if necessary as opposed to care provided by the county which only offers medication. The patient's strategy? Admit that she lives in this nation illegally. Bold.

Now, I am not in support of every immigrant having to take such a leap in our current immigration-reform environment; but that isn't the issue. When terminal or chronic and progressive illnesses strike, certain compromises need to be made, especially in a country where, every now and then, something good can happen.

And surprise: For as many citizens who don't want an illegal immigrant on a liver-transplant waiting list when supplies are low and costs are high, there are humanitarians in medicine and the field of medical ethics who believe that a hospital should not drop a pediatric immigrant transplant case -- or any other type of chronic case -- just because the patient has reached the legal drinking age.

It is a terribly imperfect system, to be sure. But I don't just feel for these patients as a chronic disease sufferer who received a transplant during the pediatric period of my life. I see and hear about what these patients deal with firsthand as the husband of a cross-cultural health-psychology researcher who, among other things, assesses quality of life and depression in monolingual immigrant patients with similar circumstances.

The facts: These patients are under tremendous stress outside of their medical predicaments -- as if they need anything else to worry about. Other cultures also sometimes view chronic illness differently than the mainstream American data-set--disease isn't just "bad luck" or something that can be "fixed." Some patients from other countries, for instance, may consider one disease a curse or punishment. Some may never tell family members. Some may not seek treatment consistently enough without strong reminders. Some simply aren't as pro-active as some Americans who grew up with the idea of preventative medicine. These factors need to be considered when rendering a decision about medical care for non-citizens.

In fact, it's even harder to be a sick young adult as an illegal resident -- and I say that knowing how terribly difficult it is to weather multiple conditions of this severity as an American citizen. When these 21-year-old immigrants received livers as children under state-supported insurance plans, they didn't ask for American care. They didn't ask to be here at all, most likely. We cannot hold them responsible for a choice they didn't make, and to ignore them would show some of the lowest regard for human life I can imagine. While these patients may not pay the same taxes as other American residents, notifying the government of their status is not as simple as it sounds. It is a brave and risky measure. One with potentially harsh repercussions for their families that should be rewarded with the same care that would be given to any American child.

For the record, oncologists consider patients "pediatric" up to and sometimes beyond 20 years of age. But the public has caught on to this labeling due to powerful cancer survivorship networks like that of Lance Armstrong's (love him or hate him). Liver disease and other ailments that strike patients up to this age, and perhaps beyond, should also be considered pediatric. And pediatric patients --for starters, at least -- should have a reliable medical support system in this country regardless of how or when they arrived on these shores. As Dr. Michael Shapiro, the vice chairman of the ethics committee for the liver network, said in Gorman's LA Times piece: there's probably a better chance that more illegal immigrants donate organs in America than those who receive them.

So let's pose the question to candidates, regardless of political party. The results could elucidate not who is ultra-conservative or ultra-liberal--who cares for the poor and who shuns them--but who really values human life. And wouldn't knowing that be a little more interesting than getting nitpicky about whose national health plan will do exactly what before it's even put into place?

Follow Adam Baer on Twitter: www.twitter.com/glassshallot

Comments

[Bamapossum]

How odd the author didn't state the illegal has already received THREE liver transplants,and is on the waiting list for a FOURTH;such a relief to know no Americans are waiting for a liver. In the original LA Times article,the illegal stated,without mincing words,that the U.S. OWED her free medical treatment;do Google news search for full article.
How many more transplants will she be allowed? 10? 15?

[glassshallot]

"The illegal?" What a nice way to refer to a human being!

[NABNYC]

I disagree. The solution to poverty in Mexico is not to have all the Mexicans move up to the U.S., or just send their kids up every day to go to our schools or to go to our hospitals for free medical care.

The taxpayers of the U.S. work and pay taxes so that services will be provided to the citizens. Our local services are being overwhelmed by illegal immigrants, mostly from Mexico. Every person who is treated in the U.S. , and cannot pay, is actually being provided health care by me, and the fact is I just can't afford it.

Another problem is that doctors and hospitals in the U.S. charge obscene amounts for services. Anyone who wants to help provide medical care to Mexicans would be better off contributing to a hospital in Mexico staffed by Mexican doctors and Mexican nurses.

The U.S. government should seal the border and tell the rich people of Mexico to start helping their own people. There are many wealthy people in Mexico, but they don't pay taxes and won't invest in their own country. Their safety valve is to send all their people illegally to the U.S. The U.S. should tell them to build schools, housing, hospitals, invest in their own economy, and then we'll talk about cross-border trade. But until that happens, seal the border.

[Giranimal]

Your "gated community" approach simply won't work. How do we prevent diseases, infections, epidemics? Certainly not by turning people away from doctors.

If we exclude 30,000 people from hospitals in the United States, we will end up with an enormous public health crisis. Influenzas, infections and diseases spread much more rapidly among people who go without medicine or treatment. Even if you build a high wall around your own hospital, the germs and the bugs will get through. If you care about your own health, you should fight for everyone's health. The emergence of drug-resistant staph infections has made it painfully clear that when it comes to medicine, there can be no gated communities. We truly are interconnected.

[leftbehind2000]

and here I thought this was another Miley Cyrus article...

[TuffPosh]

It would be great to ask about this, because it would reveal the real humanitarians and those who support rational policies. Of course, that wouldn't be in the way that Adam Baer thinks.

This topic involves very limited resources, and almost every time that an organ goes to a foreign citizen that represents one that won't be given to a U.S. citizen. So, Adam Baer would have his own fellow citizens suffer or die in order to give organs that they could have received to foreign citizens.

The only rational policy in this case is to take steps to make sure that the home countries of those foreign citizens take care of their own people. That is the only rational policy, the only one that does the greatest good and least harm.

[glassshallot]

Is a kid who was driven or flown over the borders of this country before he or she was old enough to make such a decision for him or herself supposed to be sent back to his or her home country after already having received customized care by specific physicians in the US? What's irrational is failing to understand why a pediatric liver transplant recipient who underwent the procedure and received care in the US by a specific medical team should need to continue care in the US with that medical team.