In the early days of the 2020 Democratic presidential race, when you could field an entire baseball team with the roster, The New York Times asked the candidates what kind of access they’d provide to illegal immigrants under a government-run health care system.
Almost all of the 19 candidates polled said, yes, they would give access to illegal immigrants under a universal health care system such as “Medicare for All.”
“President Trump was gleeful,” Jan Hoffman wrote in the July 3, 2019, Times piece, “predicting that the response would prove politically toxic for his opponents.”
“All Democrats just raised their hands for giving millions of illegal aliens unlimited healthcare,” President Donald Trump’s tweet read. “How about taking care of American Citizens first!? That’s the end of that race!”
All Democrats just raised their hands for giving millions of illegal aliens unlimited healthcare. How about taking care of American Citizens first!? That’s the end of that race!
— Donald J. Trump (@realDonaldTrump) June 28, 2019
Leaving aside the thorny issue of taking care of American citizens first in a pandemic, which I doubt Trump was talking about — no one should be turned away from a hospital at a time of great need, nor, indeed, is it ethical or lawful to do so — it raises the question of why people who wouldn’t necessarily pay into the American health care system to the same extent a citizen would (if at all) should be given free access to that bed in a time of scarcity.
We live in a time of unusual scarcity of finite hospital resources, which is why we keep on talking about flattening the curve. We want the pandemic to be over quickly, of course, but that would likely require a massive, exponential spike in the number of people who would have it, leading to health care that would be little more than triage for some patients.
Even with a flattened curve that lasts longer, however, health care resources can’t be ramped up in a short enough time to prevent a shortfall of beds or equipment such as ventilators. We don’t know much about the path the virus would take, but we also know that won’t be nearly enough to keep up with demand.
As BuzzFeed noted in a report last week, there are roughly 6,000 hospitals and 900,000 hospital beds nationwide. In a moderate flu situation like the 1968 flu season, it said, millions of beds were required.
And then there are ICU beds. Two hundred thousand patients were put into intensive care during the 1968 outbreak. That was moderate. In a severe pandemic like coronavirus appears to be, 2.9 million ICU beds would be needed.
“As a comparison, there are about 46,500 medical ICU beds in the United States and perhaps an equal number of other ICU beds that could be used in a crisis,” Eric Toner and Richard Waldhorn wrote in a Johns Hopkins Bloomberg School of Health study last month.
“Even spread out over several months, the mismatch between demand and resources is clear.”
This is repeated, ad nauseam, across the country. In Texas, a state with one of the largest populations of illegal immigrants in America, the Texas Tribune reports there are “about 2.9 hospital beds per 1,000 people — less than one-fourth the rate of South Korea.”
“Capacity is a big problem if this thing continues to continue to prove to be a nasty bug,” an emergency room doctor who works throughout Texas told the outlet.
“The doomsday scenario that we’re worrying about is what does a relatively small hospital do when we’re using all four or five of our ventilators.”
“We feel comfortable with … the information that we received with regard to ventilators,” he said at a Tuesday news conference. “Some [hospitals] had numbers larger than what I anticipated, and so there is no great urgency about that right now, but we want to be prepared and make sure we have as many as we could possibly need.”
As of Tuesday, Texas had 76 confirmed cases.
What is clear is that we might — in fact, probably will — need every hospital bed in the country.
If you’re in the country illegally, you’re generally unable to sign up for Medicare or Medicaid, although certain states make exceptions. If a “Medicare for All” program were adopted, however, not only would they be signed up but they would also receive coverage free of charge.
Now, there is such a panoply of problems with “Medicare for All” that have been exposed during the coronavirus pandemic — both a priori and a posteriori — that we should already have enough pause toward adopting it. (We don’t, sadly.) However, consider this: If a pandemic like this were to occur under that system, you would have to pay for individuals who never paid into the system in the first place.
There shouldn’t be an issue with giving these individuals a bed. We should, however, more than just raise an eyebrow at the idea they should receive that bed free of charge.
If they hadn’t been in this country illegally, after all, they wouldn’t be occupying that bed. They’re here, however, and if they need emergency medical care, it’s inhumane to deny it to them.
Still, they shouldn’t freely benefit from a system that they haven’t paid into, particularly when they took up resources in a time of scarcity.
It’s a difficult situation in that you don’t want to set up a system so onerous they don’t come to be treated, yet these individuals would be taking up government-controlled hospital beds and respirators. That’s impossible to balance.
Or perhaps we can just keep the U.S. health care system as it is, where those programs aren’t extended to illegal immigrants, even as we refuse to turn them away from our emergency rooms?
I doubt the president is gleeful at this moment. I’d hope not.
That poll of Democratic candidates, however, might come back and bite them given the continued exponential spread of COVID-19 — particularly when it starts taxing a system they want our government to subsume with a heap of our tax dollars.
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