illegal immigration and impact on medical field

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  • #107551
    ddadocddadoc
    Participant

    I know I’m opening up a can of worms with this topic. I even did a forum search assuming this topic was probably covered recently given all the recent legislation, demonstrations…
    Any thought on the whole illegal immigration issue from a standpoint specifically on it’s impact to the medical field, healthcare expenditure?
    I try to be very objective, and I can understand the side of those demonstrating for the rights of the illegal immigrants… however, as a healthcare professional, it’s frustrating to me to see how much money goes into unpaid medical expenses for visits to the ER, hospitalizations at University hospitals by undocumented people, etc, etc… I live in Texas and we obviously see it more than some other states. It was frustrating for me during residency and med school to be unable to communicate with quite a few patients because I don’t speak spanish/having to rely on a translator to show up. people assume I speak spanish because i have a spanish last name, but it’s a married name (my husband is half Mexican. Obviously, as healthcare professionals, our duty is to take care of the patient without judgement on other factors…

    It’s frustrating for me to see Americans in my clinic who do work hard but are struggling so hard with medical expenses because they have poor healthcare coverage, but don’t qualify for other assistance. But you can go to a border town on the American side and the clinics there are filled with patients who somehow are all on Medicaid.

    I know there is no easy answer… but I would like to limit this topic just specifically to how this affects the medical side of things… I don’t anticipate that 12 million people will be sent back to their country… however, we have a significant number of people (and still will continue to grow) who will make minimum money, who will be unable to afford healthcare if something were to happen, who will eventually get older/sicker, etc…. our hospitals are already burdened by them, what’s to happen in another 10 years?

    #107553
    Doc201XDoc201X
    Participant

    Obvioulsy the US is going to have to make some changes to how it distrubutes healthcare. However, to look at the immigration issue as one that just effects healthcare is one sided and IMHO you can’t fairly talk about the negaitive impact of immigration without looking at all the benefits. Immigrants are often willing and from what I’ve observed do a fantastic job of, performing jobs many in our society don’t want so the tax monye they pay goes INTO the medicaid fund. And my personal belief is that any person working that pays into the system has a right to use it when it is necessary. It’s simply the humane thing to do. Second, my quest to become a physician has been made much easier by a mexican immigrant nanny I occasionally share with a divorced Mom.

    As for the language issue the way I see it, with the except of most slaves, we are ALL decendants of immigrants and so the language we should ALL be speaking is one of those that represents any of the Native American togues that were spoken here before their land was stolen/purchased at a ridiculously cheap price. I think it’s just time to learn to speak spanish (which I can already do a little).

    Yes, immigrants make minimal money now, but I imagine that in a generation of 2, they will eventually catch up. With few exceptions many immigrants that came through Ellis Island had nothing but the shirts off thier backs and they managed to within a generation or two, begin to prosper finanically. I have absolutely no reason to believe that current immigrants, if given citizenship will more the “make up” for whatver drain they have caused on the healthcare system.

    #107555
    ddadocddadoc
    Participant

    I think it’s great that you’re so idealistic and optimistic…

    That said, in my ideal world, I’d have the time to learn Spanish… but frankly, it’s just one of a hundred things on my list of things to do… and with 2 kids, job, etc, I just don’t have the time, so I’ll just have to deal with that myself. I don’t think it should be necessary that we all need to learn spanish. (it’d be nice, but we shouldn’t expect it)

    And obviously, I know that this issue doesn’t just affect the medical side… I just wanted us to focus on that aspect since the topic in itself is so broad and affects every part of our lives.

    I do think that if we’re going to allow everyone to stay whether they’re legal or not… and they are in the lowest paying jobs… their options for healthcare are limited; do we need to start going ahead and offering them preventive care, routine check-ups, etc… so that we don’t face more cost by their trips to the ER, chronic diseases in the future, etc?

    I think like most Americans, I’m kinda in the middle on this topic. Obviously, illegal immigrants contribute a lot to our society… whether it evens out all the negative impact, I honestly don’t know.

    #107557
    medstudent31medstudent31
    Participant

    Do illegal immigrants really pay taxes? I thought they were paid under the table because no Social Security number, etc.

    #107559
    Doc201XDoc201X
    Participant

    Originally posted by ddadoc:
    [b] I think it’s great that you’re so idealistic and optimistic…
    [/b]

    Introducing arguements with these types of statements imply a lack of sense of what the true issues are in having with this discussion (there seems to be geenral theme here on mommd that premeds don’t know anything :rolleyes: ). At almost 40 years old, I can assure that my arguements derive not from a naivete about how the real world works but primarily from the position of caring about the well being of others. Moreover, the consequesnces of not responding to the basic health care needs of a portion of our population often results on a bigger impact on the healthcare system than would normally have been seen.

    Originally posted by medstudent31:
    Do illegal immigrants really pay taxes? I thought they were paid under the table because no Social Security number, etc.

    There are many, many articles on the internet discussing the fact the illegeal immigrants DO pay taxes. Here’s one from CBS online:

    http://www.cbsnews.com/stories/2003/04/14/politics/main549153.shtml

    Even with fake SSN’s, they pay taxes.
    The fact that many americans don’t realize that the majority of illegeal immigrants pay taxes is part of a larger scheme to drum up support for their exclusion from society. But I say how can you exclude a group of people who are already here AND in great numbers?

    So perhaps the answer for those who live in states that border the entryways of illigeal immigrants is to 1) Impress upon the politicians in states that border Mexico (since people don’t seem to be complaining about immigrants form here than other places :rolleyes: ) to do more to secure the borders 2) Require that in border states, physicians be required to speak spanish in much the same way as board certification is required 3) Offer immigrants preventative services, routine check-ups ect for reasons mentioned above. 4) Develop programs for the admisison of mexican/spanish speaking students into med school with the requirements that they complete residencies/work/practice in states like Texas for a few years. 5) Require the IRS send a large portion of the money they collect in taxes back to those states with high numbers of illegal immigrants,like Texas and California. This one is HUGE.

    The solution to this problem won’t be easy and will require compromise from EVERYONE in some form or another, but with some compassion for the health and well being of others being the driving force, a viable one can be implemented.

    #107561
    MaturinMaturin
    Participant

    Truly a can of worms, but I have to add my two cents. Illegal immigrants do, indeed put an undue burden on an already overtaxed healthcare system. Sure, some immigrants do pay taxes by obtaining a fake social security number, but most do not want to risk the chance of discovery and deportation (personal experience in the agriculture and construction industry). What the burden from illegal immigrants vs hard working legal Americans without healthcare is, I do not know, but I imagine they are about equal? This presents two problems for legislators: 1)Healthcare reform and 2)illegal immigrants. Which, leads us to this discussion. Certainly, we cannot turn an individual away if they are legal or illegal, as we have an obligation to the public to provide equal access to healthcare, but at what cost are we doing so.
    I spent several years in a rural clinic, that had a moderate illegal patient base. The patients, who came to the clinic, payed their bills better than some Americans. Even in the workman’s comp clinic, employers of the illegal immigrants were (mostly)very good about paying for procedures. The problem arises with hospital stays, surgical procedures, etc. This is where the healthcare field, really feels the crunch. Sure, alot can be written off, but that just helps with the hospitals tax burden, not actually paying staff. Another problem, too, is illegals often do not seek medical attention, until they have reached an advanced stage of their disease, making it more expensive and difficult to treat. I hate to be so wishy washy, but the reality seems to be this way. There is good and bad in everything.
    One important thing to remember here as well, is that our country is at war with terrorism (whether you agree with it or not) security is at issue. If you look at our country during times of war, specifically world war II, when our country packed up the Japanese (legal and illegal) as they were seen as a security threat. I agree that as physicians, patients cannot be treated with any sort of prejudice, but in an era, where we (VA hospital) routinely undergo disaster training and drills, it is difficult not to be aware of the security threat. (Mexico and Canada are huge and easily penetrate borders). I am in no way implying that the Mexicans will somehow aid the radical Muslim groups, who so dislike western culture, but just saying it is something to think about.

    #107562
    Doc201XDoc201X
    Participant

    Originally posted by LEG:
    One important thing to remember here as well, is that our country is at war with terrorism (whether you agree with it or not) security is at issue. If you look at our country during times of war, specifically world war II, when our country packed up the Japanese (legal and illegal) as they were seen as a security threat……. it is difficult not to be aware of the security threat.

    It would appear to me that the biggest threat to American Security is Americans. Oklahoma City is the one case that comes to mind and the attacks on the pentagon/world trade center may have very well been prevented had WE paid a little more attention to what was going on in the world. Remember, the uS has a chance to apprehend Osama years before the attack on the pentagon/world trade center.

    And the rounding up of the Japaneses was simply an imhumane thing to do which is probably why they received financial reparations for their trouble. However, since the Japanese are used in this example,can anyone deny the great contributions they have made, particularly in medicine and science to this country?

    Originally posted by LEG:
    Another problem, too, is illegals often do not seek medical attention, until they have reached an advanced stage of their disease, making it more expensive and difficult to treat. I hate to be so wishy washy, but the reality seems to be this way. There is good and bad in everything.

    This is the same thing I hear about “legal” minorities like Blacks and Hispanics and this would be a could place for a focus on preventative services. But more than that, we have to train profesinals to go into these communities and speak about healthcare. Here is where having more Black/Hispanic matriculants into med school could make a HUGE difference.

    Bottom line is that healthcare is GOING to feel the crunch no matter what. We have a choice to continue to go on the defensive like we always are when it comes to solving problems of national importance, or we can for the first time be offensive and develop the type of programs which will lead to better healthcare options and health for EVERYONE who lives here.

    This isn’t just an issue of illegeal immigrants impact on healthcare costs but of the poor poeple as well who live in this country and don’t have/can’t afford decent healthcare.

    Honestly all it takes is the outbreak of one incurable disease (like bird flu) among a poor population of people for ALL of us to get our acts together and develop a sound means of dealing with the healthcare problem in the US. An immigrant that comes down with Bird Flu or any other incurable infectious disease is going to end up in the SAME ER you’re in when you visit after your son breaks his arm. My question is, how many people have to die needlessly before a specific course of action is implemented? We may not “care” too much now about illgeals having poor healthcare options but it’s just a matter of time before thier healthcare problem becomes ours in more ways than we are prepared to deal with.

    #107564
    ddadocddadoc
    Participant

    “pathdr2b”… I respect your opinion and idealism… but come on… asking that border states need to require their physicians to learn spanish… come on, we have enough hurdles to go through as it is. And med schools do try hard to recruit minorities… unfortunately, in Texas, there was a lawsuit several years ago which found affirmative action illegal and since then, the number of minorities in med school has dropped.
    I’m curious what your current situation is right now? Are you still in med school, in practice? Actively seeing patients. I think it’s one thing to make statements when you’re not in the day to day of dealing with these things…but experience does change people’s perspectives. I think most of us who entered into medicine went into it with all your idealism… and we can’t be judged for losing some of that idealism after we see what the reality is… there is no simple answer… and no matter how many complaints there are about our healthcare system, I wouldn’t trade it for any other country’s… a lot of countries won’t even treat you in an emergency unless you have money. We are a very compassionate country in that in times of emergencies, etc… we do treat and ask for money later (which often is not even collected). There are a lot of disparities in healthcare… but that’s a whole another topic.

    #107566
    Doc201XDoc201X
    Participant

    Originally posted by ddadoc:
    I’m curious what your current situation is right now? Are you still in med school, in practice? Actively seeing patients.

    Ok, here we go again. Why is it that the docs THIS site and women not surprisingly :rolleyes: ALWAYS pull this premeds don’t know jack ****, stuff ANYTIME there’s a debate about medicine??? Well guess what, medicine is about a hellva lot more than PRACTICING but then again LIFE in most ANY career is more than about the career itself. And you think I’m naive? Anyone who has had a demanding a career (Ohh, and docs aren’t the only ones with demanding careers either :rolleyes: ) knows this much. The strategy I set out for resolving this immigrant impact on health problem (where’s yours, BTW) was about how anyone and everyone who is being impacted by then can do their part. FYI, I’ve been an ADMINISTRATOR of a state public heath program in a state with a LOT (Florida) of immigrants so my “opinion” aren’t just being pulled arbitrarily out of my arse! Have you ever administered a state public health program? But it’s funny once again that since I’m not an MD, my comments about this point aren’t valid.

    The word I am is REALISTIC about medicine and it seems to me that the people who complain the most about it are those who weren’t “real” when their journeys began. I’m quite realistic about medicine. Having more than 2 natural kids and trying to be a doc won’t work for me. Doing an internship year won’t work for me. Working as a part-time Doc isn’t going to work for me since I’d like to become an expert in my field before I’m 90. Marrying a doc wouldn’t have worked for me because SOMEONE has to have a schedule flexible to fill in when I can’t be there and that will happen a LOT. Working in Texas or California wouldn’t work for me because my Spanish is way too rusty even though they say once you speak the language fluently (which I learned to do when I lived in Fla 😉 ) you get it right back. Working in rural medicine wouldn’t work for me because I value personal time with my family and wouldn’t want to have to explain scripts to a patient while I was there picking up my own. Becoming a Family Practitioner wouldn’t work for me because I don’t like the idea of having a career where I know a little about a lot and prefer instead to know a LOT about one particular field. Becoming a pediatrician wouldn’t work for me because quite frankly I’m desperately trying to avoid specialities with lots of OTHER women. And men don’t bitch nearly as much as women :rolleyes: Being in a primary care field wouldn’t work for me because I like having a reasonably set beginning and ending to my work day and NO call. Being a surgeon wouldn’t work for me because I have bad back despite having effectively sliced and diced many a lab rat in my day (translation, I have great hands for surgery).

    So as you can see, I’ve spent a Lot of time thinking about medicine and working around docs where luckily for me, I feel that I’ve been given the TRUTH about the practice of a field that is bound to change probably more than any of us could imagine today. And what today’s premed needs to think about when she decides on medicine that what’s UNREALISTIC are many of the complaints/demands many young female doctors want today. There is NO “having it all” at the same time, and in the same “quantity”!!! If you want to have a say in your schedule while working with patients, nursing is a great option. But I’d also like female premeds to consider the advantages of being highly adaptable to change without stubbornly and childishly
    “stopping their feet” when they don’t get their way. That, and seeing the glass as half-full doesn’t hurt much either. 😉

    I presented a strategy for how your original question could be addressed. Perhaps it’s best to refrain from further discussion (and insults to if you don’t mind) until you present one yourself.

    #107568
    Doc201XDoc201X
    Participant

    Originally posted by ddadoc:
    I think most of us who entered into medicine went into it with all your idealism… and we can’t be judged for losing some of that idealism after we see what the reality is..

    I’m a person who thinks 25 should be the minimum age at matriculation into med school, so perhas my response to this comment is moot. It’s not a matter of being judged for being idealistic as you call it, to me it’s about the idea that you have to “sleep in the bed you made for youself”. The fact is that too many people go into medicine for all the wrong reasons then wonder why their unhappy? Well duh! Many times on this site, docs say that people tried to warn them abou tthe pitfalls of certain specialities well guess what? I’m one whose actually LISTENING when people with more experience in a specific area talk to me/post messages. I have yet to meet an unhappy pathologist and they ALL have families so besides my strong interest in this field (complete with home microscope and being good on the ol’ back)) choosing this field NOW seems like a no brainer to me. Irronically, I don’t know a single person in their 30’s or older(aka oldpremeds website) who decided to pursue medicine and is now unhappy with their decision.

    In my mind it’s too easy to “see the reality” of medicine BEFORE you matriculate and I’m not talking about theose “fluffY’ volunteer health expereinces you guys put on your med school applications. Wanna know what it’s like to treat poor patients? Then “sashey” yourself down to the local homeless shelter or public health clinic. Want to know what It’s like to be a surgeon or OB/Gyn? Shadow one on call for 36 hours or better yet, don’t shadow but meet with them for coffee AFTER such a 36 hour shift.
    Do these types of experiences replace the actual practice of medicine? Of course not,but for those who are willing to LISTEN, they are valuable expriences that can easily be used to make smarter career decisions in the future.

    I’m curious, what exactly did you think practicing medicine (I’m assuming you’re in a primary care field) in an area of Texas near the border would be like? I’ve been to Texas once (last year in San Antonio for a meeting) and what was painfully clear to me during that one week I was there was that IF I were planning on living in Texas as a Physician, speaking spanish fluently would not only be a great help to me personally but professionally as well. And accoring to 2 friends, one who is an MD/PhD and the other a PharmD both living in Texas, speaking the language gives you an advantage when negotiong a salary as well!

    So in my mind, at some point you have to either say to yourself that I made a wrong decision somewhere, with speciality choice or in choosing where to live, ect or that I was too stubborn to listen when people were giving me advice. But what I don’t think ANYONE can fairly do is blame ANY career for their unhappiness because ultimately we make CHOICES. Happiness or the lack thereof, begins and ends with YOU and you cart it around no matter what career you choose.

    OK, i’ll get off my “don’t worry, be happy” soapbox now! 😀

    #107570
    efex101efex101
    Participant

    As a Latina this topic hits home really hard. I for one do not think that physicians in any area of the US should “have” to speak *any* language aside from English. It breaks my heart to realize how much America is trying to “accomodate” for ALL folks moving in. If in the next ten years or more we have a huge influx of let’s say Koreans and the map starts changing in some areas should we have to then Korean? this can open a HUGE can of worms. Immigrants that go to any OTHER country HAVE to learn the language that is primarly spoken in that area. I grew up in Spain and ALL folks (Germans,Swiss,French,Italians) that moved to Spain INDEED speak Spanish. Why do we as a country must always have to accomodate ALL cultures/languages that come here AND change the way WE do things? do not get me wrong change to a certain extent IS good to a certain point. I think that we as a country have been more accomodating than any other country in the world!
    About legalizing the status of immigrants I think that there is no right answer. If you do legalize their status how will ALL OTHER immigrants (including Hispanics) that had to go through the proper channels to become a US citizen feel? why do some folks have some rules and others do not? why do people outcry in rage when this Kennedy congressman was allowed to go home w/o a sobriety test (which I think is wrong) and he was given another set of rules YET we are “considering” allowing all these immigrants legal status? I mean this is like an oxymoron. I do agree that these folks ARE providing a lot to our country but they ARE here illegally! and as far as I know that is against the law right? I am not condoning deporting this guys en masse for many agricultural areas will be at a great loss of workers but I am also not for just “letting” them have at it and become US citizens like magic for this would be a slap to the face of the many other immigrants that waited their time out.
    This country is going to go down the drain slowly but surely IF we keep making concessions for ALL folks that come in here. Do you guys think for ONE minute that we could take our little arses to any other country and DEMAND to have physicians that speak OUR language? demand that business have folks that speak our language? demand that they give us instant citizen status? hell no!

    #107572
    AnnaMAnnaM
    Participant

    I do prenatal care in an outreach clinic where about half of the pts are probably illegal, and about half of those don’t speak much (or any) English. Knowing Spanish certainly helps, and I am drawing on 6 years’ worth from 35 years ago. I can get by most of the time, but we have a translator for the tough stuff. Last Friday one of our patients walked in unannounced. She had been diagnosed by ultrasound with a severely malformed baby and had terminated 8 days before. She had made a suicidal geature with a knife the night before but refused to go to the hospital. Her husband wanted me to give her some pills and make her better. No English, of course. In this kind of situation I feel helpless even with a translator. I simply cannot say all the things I want to be able to say to her, and explain that there is no pill that will make her better right now. I tried, but I could tell just by listening to the translator that what I was saying was getting hopelessly lost in the translation. We were able to find her a counselor who spoke fluent Spanish and had time to talk to her in 2 hours (not an easy thing in a town of 9,000 in the middle of a cornfield—and the counselor accepted public aid too!) I resent any suggestion that docs be REQUIRED to learn a foreign language. I have Chinese, Vietnamese, and Yugoslavian patients too. Should I be required to learn multiple languages? I don’t know if many of you are aware of this, but as of July 1, patients are going to be required by the federal government to produce a valid US passport or birth certificate to get a public aid card. This is really going to complicate prenatal care in my state, as we currently don’t require same, on the premise that these women are carrying future citizens that the state will be responsible for once they are born, and we all know that well-baby care is cheaper if it starts in utero.
    I don’t have a big gripe against immigrants of any kind (my grandparents and great-grandparents were illegal immigrants who snuck in through Canada). What I do object to is the refusal to assimilate. I have no problems with preserving one’s culture, but this brazen attitude that we are going to turn the US into Mexico and the refusal on the part of some to learn even basic English just irks me. I spent 2 weeks in Denmark with my kids a few years back. We quickly learned how to read important signs and learned a few basic words. My nephew was there a year and was practically fluent. Danish is an extremely difficult language to learn. I understand that English is too, but when my grandparents came here, they realized very quickly that you don’t dig in your heels and demand that people cater to you in this country. You get off your butt and learn to survive, and that includes learning how to communicate.
    Well, those are my random thoughts on immigration.

    #107574
    Doc201XDoc201X
    Participant

    Originally posted by efex101:
    As a Latina this topic hits home really hard. I for one do not think that physicians in any area of the US should “have” to speak *any* language aside from English. It breaks my heart to realize how much America is trying !

    First, I NEVER said that immigrants shouldn’t have to speak English, of course they should but this argument about focusing on English is bogus because the US didn’t ALWAYS belong to gringos! So technically, we are ALL here illegally!

    And America is FAR from accomadating everyone. When was the last time a boatload of Hatians was allowed in?

    And yes, if a HUGE influx of Koreans come to America and YOU want to WORK in that community, what so wrong with learning some Korean? I thought medicne was a career of “always” learning something new. :rolleyes:

    And allow me to be clear. I’m speaking of giving citizenship to the folks who are ALREADY here, AND shoring up the borders which is pretty much what I already stated previously.

    Originally posted by efex101:
    If you do legalize their status how will ALL OTHER immigrants (including Hispanics) that had to go through the proper channels to become a US citizen feel

    First things first, lets first take care of those immigrants that could potentially have the biggest impact on both the politics AND economy of our country.

    #107577
    Doc201XDoc201X
    Participant

    Originally posted by AnnaM:
    I resent any suggestion that docs be REQUIRED to learn a foreign language. I have Chinese, Vietnamese, and Yugoslavian patients too. Should I be required to learn multiple languages?

    WAAYYY too asinine to respond to! :rolleyes:

    Originally posted by AnnaM:
    [b]I don’t have a big gripe against immigrants of any kind (my grandparents and great-grandparents were illegal immigrants who snuck in through Canada). What I do object to is the refusal to assimilate. I have no problems with preserving one’s culture, but this brazen attitude that we are going to turn the US into Mexico and the refusal on the part of some to learn even basic English just irks me. You get off your butt and learn to survive, and that includes learning how to communicate.
    Well, those are my random thoughts on immigration. [/b]

    Turn into Mexico? You MUST be a republician! :p Excuse me, but what we call Texas once WAS Mexico, so you may want to double check your America History before making another comment like THIS one.
    :yes:

    The fact is that many immigrants for whatever reason aren’t learning english, so what are you going to do? Deport them back to Mexico? Then happens to their children who were BORN in the USA? Will we set up orphanages for them? I tell you this is a recipe for breeding homegrown terrorists in your OWN country. Are we going to refuse them healthcare because they don’t speak English? Well now that doesn’t sound like the compassionate doctor so many of us hoped to be to me.

    You know, I’m STILL waiting on a response of what we CAN do intead of trying to tear my responses to pieces. :rolleyes:

    #107579
    Doc201XDoc201X
    Participant

    Originally posted by efex101:
    As a Latina this topic hits home really hard. I for one do not think that physicians in any area of the US should “have” to speak *any* language aside from English.

    When I was a volunteered in the ‘hood, I spoke ebonics with some patients and also served as “translator” of sorts to those PHYSICIANS and nurses who didn’t. I see speaking the “language” just as important as providing healthcare, because your ability speak the language could potentially effect your ability to provide care.

    No, I’d venture to say that the reason folks have their boxers and thongs in a bunch ove rthe immigration issues is because one day, those with brown skin will one day RULE this country. Of course, that means that things will return to the way the USED to be.

    I guess I’m so passionate about this issue because I’m a little bit latina but a lotta bit Native Amercian (1/4). More than that, I haven’t forgotten HOW this country was “founded” and all the tens of millions of lives that were destroyed making this an english speaking country. So this idea that English SHOULD be the ONLY language spoken here is just ridiculous in a country that was 1) STOLEN from the people who already lived here and 2) Is full of so many immigrants anyway. But I guess all this makes me an idealistic premed! 😀

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