Health care and illegal immigrants in America: why Mexico is the key

Few issues have caused as much of a stir this year as the question of whether illegal immigrants will be included in the Democratic healthcare bill.

Rep. Joe Wilson's "You lie!" outburst after President Obama stated in September that illegal immigrants wouldn't be covered is just one example of the tension. Eighty percent of Americans are loath to subsidize illegal immigrants according to a June 2009 Rasmussen poll. Amid a wobbly economy, the uncertain – though certainly high – cost of the health care bill contributes to such hostility.

But there's something that might help solve part of the problem, satisfying both Democrats and Republicans: a campaign by Mexican officials to improve the state of healthcare in their own country.

Mexico's healthcare system is corrupt, unwieldy, and grossly underfunded – and it's costing American taxpayers big-time. Consider this: The Mexican government spends $535 per capita on healthcare, yet American taxpayers fork out more than $1,100 in healthcare for the 12 million-plus illegal aliens in the US – most of whom are Mexicans who are uninsured or on Medicaid illegally.

Mexico's poor quality of healthcare is a forgotten factor that drives so many Mexicans across the border. As things stand now, illegal immigrants – like all who show up – cannot be turned away from hospital emergency rooms, for anything from a broken bone to illness and pregnancies. Each year, about 1 in 10 births in this country are to illegal aliens.

In general, they receive better quality care than what they could hope to receive back home. Even though lawmakers insist that healthcare reform wouldn't subsidize care for illegals, US taxpayers in practice will contribute to covering the cost of their care. If Mexico had better structure – and Congress can and should encourage such self-help – perhaps the US wouldn't have such a burden on its own system. Instead, Mexican leaders, who often live like princes, prefer to shift the obligation to the US, and America is taking the bait.

Inadequate funding isn't the only problem with Mexico's system: It staggers under the poor delivery of services, a venal labor union linked to drug smuggling and selling jobs at public healthcare agencies, and a Balkanization of the government-subsidized providers.

In addition to the Mexican Social Security Institute (IMSS), which provides health and retirement benefits to 45.8 percent of the population, there are individualized programs for government bureaucrats, oil workers, the two electricity companies, the armed forces, and the extremely poor.

The multiple agencies and state-federal overlap of functions accentuate delays, errors, overhead expenses, and corruption. No wonder Mexico falls at the bottom of the 30 OECD states in terms of out-of-pocket outlays on physician and hospital visits.

According to the Associated press, "Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness, and pine-scented disinfectant. Many don't see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu."

Mexico's National Human Rights Commission has criticized the lack of general practice physicians, specialists, and nurses, as well as "the insufficiency of beds, medicine, instruments, and medical equipment in general." To make matters worse, administrative costs devour 10.8 percent of the nation's meager health budget – more than twice the level of Medicare in the US.

Corrupt union practices compound the problem.

The Health Workers' Union has gained one benefit after another since its founding in 1944. Not only do union members boast tenured positions, relative high salaries, free medical care for themselves and their families, generous Christmas bonuses, and additional compensation for arriving at work on time, but their retirement plan is one of the most attractive in the country. The lion's share of the nation's 374,000 union members can retire with pensions in their mid-50s compared with the minimum retirement age of 65 for most other Mexicans.

So what can be done? Instead of turning a blind eye to the Mexican government's unwillingness to improve the medical care of its people, the Hispanic Congressional Caucus and other special pleaders for including illegal aliens in healthcare legislation should insist that our southern neighbor launch a root-and-branch reform of how it addresses its own citizens' medical needs.

And if the US encouraged Mexico to strive for a better system, the health bill now before the Senate would be relieved of one less roadblock.

George W. Grayson teaches government at the College of William & Mary. His latest book is "Mexico: Narco-Violence and a Failed State?"

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