I examined her axilla gingerly and was immediately met with granite resistance. My heart sank as I worked my fingers anteriorly over a bulging stony mass
in her breast. "How long has this been here?" I asked, trying to keep the doom out of my voice.
As my patient's story slowly unfurled from him I realized that there was so much I did not know about him. He was not a loner at all. He was married, with
two young children. His parents lived with him, as well as an aunt. But no one was getting any medical care because they were undocumented and worried
I also learned the he didn't just work in a restaurant -- he'd started the restaurant himself, and now employed several other people. He'd been a journalist
in Tibet until he managed to get to America on a student visa, now expired. He was the only one who spoke some English, so he was the one who ventured to
His reflux pills he gave to his father, who suffered from a gastric ulcer. The ibuprofen for his back went to his aunt, who had arthritis. And the "bump"
under his mother's arm -- well that had been there for years, and it had indeed started out as only a bump. But she was too scared to come to the hospital -- she
spoke almost no English and worried about deportation.
Everyone in the family worked -- in the restaurant, cleaning houses, babysitting -- but none of these jobs offered means to obtain health care. And so the family
stayed away. The mother's breast cancer was an insidious and implacable marker of time in the shadows.
This story is sadly typical -- immigrants afraid to access basic medical care, potentially curable illnesses spiraling out of control. Communicable
diseases -- easily treatable ones -- fester and spread unnecessarily.
As immigration reform wends its way through a fractious and polarized House of Representatives, many are thinking about the implications for health care.
From the medical perspective, bringing people into a primary care system is beneficial for our entire society, both from the public health standpoint and the moral standpoint.
But even from the economic side, it makes sense. The savings from treating illnesses early, preventing outbreaks of communicable disease, screening for
treatable chronic illnesses and vaccinating to prevent disease are entirely obvious.
On a larger scale, however, immigrants' relative youth, health, and productivity are a boon to the medical system. A recent study showed that from 2002 to 2009 immigrants as a whole contributed an estimated $115
billion more to the Medicare trust fund than they took out. In 2009 alone, immigrants offered a surplus of nearly $14 billion, while U.S.-born people
generated a deficit of more than $30 billion. Most of the surplus, incidentally, was from immigrants who were not citizens. This was felt to be from the
higher proportion of working-age taxpayers in this demographic.