I recently read James. F. Dwyer piece, “Illegal Immigrants, Health Care, and Social Responsibility.” Here is a brief outline.
Dwyer begins by asking: “Do societies have an ethical responsibility to provide health care for them and to promote their health?” Nationalists say no; humanists say yes. Dwyer disagrees with both answers. Dwyer’s analysis focuses on illegal immigrants (this is of course a loaded term and not altogether enlightening) and simply assumes that societies have a moral right to provide their own citizens with comprehensive health care.
He notes that migration is not new, but illegal immigration is—since only in the last hundred years or so have nations tried to systematically regulate immigrants. In the past states were more interested in controlling citizenry than residency. Migrant workers do work with the worst pay and the worst conditions—work citizens won’t do and which can’t be outsourced. In recent years, migrants have become primarily female and some of the worst moral offenses in the world occur in human trafficking.
A number of laws have recently been proposed to deny illegal immigrants health care, education, and other social services. Arguments for this position and responses to them include:
1 – “…illegal aliens should be denied public benefits because they are in the country illegally.” Response – nothing about health care follows from breaking the law. For example, if you receive income without paying taxes—break the law—it doesn’t follow that you shouldn’t get health care.
2 – “Given the limited public budget for health care, U. S. citizens and legal residents are more deserving of benefits than are illegal aliens.” Response – “The narrow framework of the debate pits poor citizens against illegal aliens in a battle for health care resources. Within this framework, the issue is posed as one of desert.”
Opponents say illegal immigrants are free riders sponging off the system; defenders point out they pay taxes and contribute to the economy. So are illegal immigrants a net gain or loss for the economy? Dwyer reframes the question. Rather than using a business model—do I get my fair share of benefits from taxes (or investments)?—other questions about social benefits are more important. Consider a public library. The question is not whether you get your fair of use from a library, but whether libraries contribute to the public good. If they do, everyone benefits from libraries, whether they use them or not.
Professional Ethics – Some physicians argue that denying care is inconsistent with what it means to be a physician, and, furthermore, that it is bad for public health, as in the case of tuberculosis, measles and other communicable diseases. But should illegal immigrants be considered part of the public? Others argue that medical confidentiality prevents reporting facts about patients. Others reply that we need to screen illegal immigrants before they seek care.
The question then is what does professional ethics demand? Emergency care only, at one extreme, or care on the basis of medical need alone, or something in between like basic health care available to all. In the end, professional ethics should oppose health care limitations, but it is does not exactly show how.
In the next section Dwyer expresses supports for the social justice argument for basic international health care. And in the final section he argues that social responsibility supports the claim of health-care for illegal immigrants.
“Providing health care for all workers and their families is a very good way to improve the benefit that workers receive for the worst forms of work, to render workers less vulnerable, and to express social and communal respect for them. These are good reasons for providing health care for all workers, documented and undocumented alike. And they express ethical concerns that are not captured by talking about human rights, public health, or the rights of citizens….”
Reflection – Universal medical care is a moral and economic imperative. And the idea that this is best done through large public health-care systems as they are found in one of their many varieties in advanced countries around the world isn’t even controversial among public policy experts. Such health care systems have better health outcomes for less cost while covering all their citizens then the American health care system. This is not even controversial and anyone telling you differently is either ignorant or lying.