Like any society on earth, the United States has to decide how to spend public money. Simple as that: economy, from a Greek word meaning household management, means we have to decide how to run the national household.
Who gets educated, and who doesn't? What communities get new infrastructure... roads, lights, water systems... and which ones don't? And finally, when does a country with a largely private health care system decide spending public money for health care for the undocumented is not charity, but prudent public policy forged by self-interest?
We don't like to have that conversation. A lot of the national debate about what to about people who have come to live here illegally revolves around not "rewarding" wrongdoing, punishing offenders, and "sending messages." What if we took a utilitarian approach to medical treatment for illegal immigrants, rather than a punitive one. What if we stopped talking for a moment about what should be, and concentrated on what is?
Recently, HITN TV produced and broadcast a compelling documentary on contagious disease and the medically underserved, "Pandemia Invisible," or "Elusive Pandemic." It took the viewer into the lives of workers who are themselves invisible to the Americans around them. It was strong stuff. We got a look at lives hemmed-in by poverty, inability to navigate the system, and unwillingness to step out of the shadows to try to get health care for themselves and their loved ones.
These are the millions of people who make your hotel beds, pick your fruits and vegetables, diaper your babies, slaughter and butcher your cows, chickens, and pigs, knock your roof shingles into place, wash your restaurant dishes after you've paid the bill and gone home, mow your lawns, trim your hedges, and raise hundreds of thousands of citizen children.
In cooperation with public health researchers at Columbia University, HITN reported on how public health threats form, how diseases spread, and how citizens who live hidden from officialdom as a way of life consume medicine and medical information. Remember, for today.... What's useful? What works? What saves money?
Illegal immigrant workers are often hurt on the job. Illegal immigrant workers head to their jobs when they're sick, unless they're so sick they can't physically manage to travel and work. Illegal immigrant workers expose their children to infectious diseases, and are exposed to them by their own children. They are unlikely, dangerously unlikely, to have received a full course of vaccinations against common diseases as part of their regular treatment, because their medical histories are so fractured and irregular.
Columbia University has run simulations of a pandemic moving through communities in New York City, trying to find the weak points in public health services and defend against disease. Not surprisingly, because immigrants use informal information networks, see doctors irregularly, don't get sick pay when they stay home from work, and shun government services, they could be the weak link in the public health chain. A dense environment like an American city, filled with closed public spaces, provides an ideal staging ground for a pandemic if a fear of discovery, the threat of exposure, keeps illegal immigrants away from hospitals, clinics, and doctor's offices.
Elected officials and American citizens who want to take a tough line on illegal immigration have long maintained that the problem is not that complicated: Just make life for illegal residents so unpleasant and so umpromising that people will simply head home, or "self-deport." It's estimated that more than a million workers have done just that in the face of a continuing economic crisis and state law's like Arizona's SB1070. So 1.2 million have gone home leaving, let's see... only about NINE TIMES that number still here.
However unpleasant life becomes for the undocumented, millions are not going home. Period. Life may be even worse where they come from. Hundreds of thousands are raising citizen children who have never laid eyes on the place to which many Americans would like them to go "home." Once you find that millions will not self-deport, well, then what do you do?
When I was a reporter in Chicago, and my son was an infant, a measles outbreak gripped my largely Latino neighborhood. Authorities started with the obvious stuff... notes home with schoolchildren... stories on the local news... But the word had not penetrated this heavily immigrant, heavily Spanish-speaking neighborhood. Young children needed to be vaccinated. The younger they were, the higher the chance a case of "sarampion" would not just make them ill, but kill them.
Light poles along the sidewalks sprouted skull and crossbones and the exclamation SARAMPION in big letters. Public health workers from local hospitals and clinics started knocking on doors to check on the vaccination status of people of all ages, and administering the shot to all comers... no non-medical questions asked. City officials made the rounds of the well-listened to morning radio programs on the city's Spanish-language stations. It took a little longer to mobilize, but at last, Chicago had an all-fronts war against death from measles, and slowly got control of the outbreak.
And yes, my little son got his shot too early to derive permanent immunity, so had to bear the pain of a needle stick again when he hit the right age. He's about to turn 22 and seems no worse off for the experience.
I'm not sure that in its current mood, America is ready for a "no questions asked" approach to medical care in general, or even emergency services in particular. We are quick to count the cost of services (and make no mistake, providing medical care is expensive), but not very interested in adding up the contributions of low-wage undocumented workers to the country's bottom line.
It's hard to count the missed days of work, the loss of productivity, even the lost years of life and added expense of treatment from workers. If you assume that what we're up to right now in America is making it as tough as possible to stay, you'll probably pick one set of options for dealing with medical care for undocumented workers and their families. If you believe that even as their lives get worse they're going to stay, you might pick a different path. Yet, even if you despise the continued presence of illegal immigrant workers in the country, the money saved by treating chronic illness early rather than late, if the taxpayer is going to end up on the hook anyway, might get your interest. Take that idea one step further, and the undocumented patient we treat today is one whose sneeze won't infect you with a fast-spreading virus tomorrow. If the worldwide spread of H1N1 showed us anything, it's this" viruses don't know there's an international border between Ciudad Juarez and El Paso, San Diego and Tijuana, or for that matter, Vancouver and Seattle. When it comes to medicine, common sense and self-preservation has to be in the mix along with ideology... or we may be cutting off our suddenly runny noses to spite our faces.