In Healthcare Debate, Dispelling the Myth of Real Change

By Michelle Chen Aug 21, 2009

Against a tide of lies and vitriol, President Obama is working hard to dispel popular myths about healthcare reform. Chief among them is the crackpot idea that universal health care actually means health care for everyone. In a chat with right-leaning radio host Michael Smerconish this week, Obama set the record straight on Republican propaganda about insuring “the illegals”:

this has been an example of just pure misinformation out there. None of the bills that have been voted on in Congress and none of the proposals coming out of the White House propose giving coverage to illegal immigrants, none of them. That has never been on the table; nobody has discussed it. So everybody who’s listening out there, when you start hearing that somehow this is all designed to provide health insurance to illegal immigrants, that is simply not true and has never been the case.

So people, don’t think for a minute that the government would act to prevent undocumented immigrants from dying of untreated diseases. Rest assured that hospitals will continue deporting them from hospitals, perhaps to die at the mercy of far worse healthcare systems, which they clearly deserve as a consequence of their lawbreaking. On the other hand, when Smerconish asked about the current status quo policy of providing emergency room care to anyone regardless of immigration status, Obama said:

Well, that will continue, because we don’t want a situation in which some child, even if they’re an illegal immigrant, shows up at an emergency room with tuberculosis, and nobody’s giving them treatment, and then they’re going back to the playground and playing next to our kids. So I think there is — there is a basic standard of decency, where if somebody’s in a death situation or a — 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.

Sure, because if we talked about caring for some of the country’s most vulnerable and exploited residents—say, through a comprehensive single-payer system—that would totally alienate the Americans still on the fence, particularly all those the gun-toting swing voters who not only don’t want to give the illegals medicine, but would prefer to just shoot some on the spot. Really, why burn those bridges? To his credit, Obama does hold the line at a “basic standard of decency"–as long as the goal is limited to keeping those TB-infested illegal children from infecting one of “our kids.” The President does dance around a salient point, though: providing care to undocumented immigrants enhances societal health in general and is ultimately cost effective. As Chris Weigant points out at HuffPo, universal protection from disease serves both selfish interests and public ones: "[Y]ou are gambling with your own health as well as those ‘illegal immigrants.’ Once again, germs do not care how much money or how much status you have — they’ll infect anyone." Obama might have used what’s left of his bully pulpit to steer the conversation toward the concept that covering everyone is not just ethical, but actually good for the country’s health. But the right’s bloviating and unabashedly racist intimidation tactics have driven politicians into a self-fulfilling prophecy of avoiding, and abandoning, the hardest questions. In a meeting with faith leaders, Obama acknowledged, “this debate on health care goes to the heart of who we are as a people.” He then blunted that moral point by hewing to the contortions of social conservatism: that a public commitment to health means denying a poor woman access to abortion services, or allowing an immigrant child to see a doctor but not her undocumented parents. So now the debate has been whittled down to tepid assurances that reform will not actually change too much. And Washington is gambling on passing nominal “reform” without expending political capital on the equity issues at the root of the nation’s health crisis. Eugene Robinson warns that cowardice among "centrist" Democrats could shred any hope of real reform:

Democratic leaders should stop backpedaling, stop apologizing and show their followers — by words and deeds — that the principle of universal health care is worth fighting for. They should even allow themselves to raise their voices at times — not motivated by anger but by conviction.

When conviction slips, the loss isn’t just political. The resistance to covering undocumented immigrants may bleed into deeper inequities even for those with green cards. The National Immigration Law Center notes that proposals for an individual mandate for universal insurance enrollment may end up imposing a five-year ban on lawfully present (and working and taxpaying) immigrants. Already in Massachusetts, lawmakers plan to cut costs in the state’s “universal” health plan by shutting out tens of thousands of documented immigrants. Adam Serwer at TAP says the policy discussion is filtered through white anxieties about a truly universal system, which would redistribute social goods to communities long deprived of it—people of color and the poor:

While the health-care bills being debated in Congress would expand access to and quality of care for people of color, ultimately racial health disparities can’t be eliminated without better distribution of health resources. That doesn’t just mean more and better primary-care providers in minority neighborhoods; it also means environmentally safe living conditions, access to fresh and healthy foods, and safer and more exercise-friendly neighborhoods. … During the presidential campaign, President Barack Obama avoided making the case for health reform in racial terms. This has continued, with the administration reluctant to point out racial disparities in access to or quality of care for people of color, preferring to make the case for health-care reform in race-neutral terms. An argument for how health-care reform would benefit the poor has also been absent. Opponents of reform haven’t been as shy about invoking race, particularly when it comes to whether the bill covers undocumented immigrants.

Ensuring health care for all immigrants is just one of many issues now sliding off the table on Capitol Hill. Yet it’s a bell weather for how ready this country is to redeem the promise of inalienable rights. The debate really does “go to the heart of who we are as people,” and it’s also about who we mean by “we.” Image: Jim Young / Reuters