Should Universal Health Care Cover Illegal Immigrants?

In an interview with right-wing radio host Michael Smerconish, President Obama said the health care bills weren't designed to cover illegal immigrants, except perhaps for children and in cases of emergency. Ryan Avent said he was "ashamed" of Obama's answer. James Surowieki of the New Yorker pointed out that most of the European countries whose health care systems we envy don't cover illegal immigrants either.


Here's what Obama told Smerconish:

OBAMA: We don't want a situation in which some child, even if they're an illegal immigrant, shows up in an emergency room with tuberculosis and nobody is giving them treatment, and then they're going back to the playground and playing next to our kids.

So I think there is a basic standard of decency where if somebody is in a death situation or a severe illness, that we're going to provide them emergency care. But nobody has talked about providing health insurance to illegal immigrants. I want to make that absolutely clear.

I think that's absolutely spot on. I share Avent's compassion as a matter of abstract morality, but as a matter of politics, and even as a matter of practical virtue, it falls short. Politically it's quite the Washington hari kari to inflame public opinion about health care reform by explaining that the $1 trillion bill is designed to extend coverage to people who are here illegally. The bigger picture is that it would be more shameful if Obama doomed the entire health reform project by planting his foot down and saying, "By God, either 6.1 million illegal immigrant adults get subsidized health care or there will be no health care reform at all!" Let's not pretend we don't know how that would end.

Practically, Surowieki makes an excellent point that if we guaranteed health care to illegal immigrants, we would turn the United States into the world's "health care provider of last resort." Since no other industrialized democracy offers health care for illegal residents, we could be flooded with requests from workers migrating to the States whenever they got sick.

Update: Ryan just responded to Surowieki, and I have to give him credit for this zinger: "First, while there are many things worth emulating about Europe, I'm not sure that attitudes toward immigrants is one of them." Check that!

Again, I'm with Ryan all the way morally. I think every person in America deserves health care. I think it's an issue of morality, of human rights. And immigrants are people, too. But it seems to me that the best way to extend health care to non-citizens isn't to mandate illegal immigrant coverage so that the world's uninsured consider the United States taxpayer their guaranteed provider of care. It seems the better way would be through immigration reform, to create incentives and avenues for illegal immigrants to become full-fledged citizens, pay their taxes, and get their proper GP check-up. But guaranteeing that they'll get coverage whether or not they become citizens-- is that the right incentive?

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Derek Thompson is a senior editor at The Atlantic, where he writes about economics, labor markets, and the entertainment business.

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