News Round-Up (12/23/09) – Unspeakable Exclusion: Immigration and the Politics of U.S. Health Care Reform

Sarah S. Willen (SMU) & Nolan Kline (University of South Florida)

Although politicians on both the right and the left have expressed their reservations, the legislative push to pass health care reform before Christmas eve appears to be moving forward at full steam – importantly, without any substantive discussion of whether excluding unauthorized migrants and immigrants makes sense.

However the chips fall, we are left with one key take-home lesson from this lengthy, dramatic legislative saga: Americans of all stripes are, and remain, woefully ignorant about the scale and scope of unauthorized migrants’ and immigrants’ health needs; about the interconnectedness among im/migrants’ health concerns and those of citizens and authorized residents; and about the reasons – practical, financial, legal, and ethical – why helping im/migrants obtain health care might be in the collective best interest.

During the most recent debate, a few rare voices have bucked this trend. In a New York Times op-ed titled “Coverage Without Borders”, for instance, Cardinal Roger Mahony, Archbishop of Los Angeles, argues that,

Medical Deportation: Outsourcing “Removal” to Private Hospitals – Luis F.B. Plascencia

Luis F.B. Plascencia
Arizona State University

Since at least 2001, an important phenomenon has emerged that has drawn some attention from the media but remains to be more fully examined by anthropologists and other social scientists: the actions of local private hospitals to remove/deport “undocumented” migrants from U.S. territory without interference from federal agencies. These actions appear to have involved primarily migrants from Central American and Mexico.

The passive role adopted by the Bush administration and now the Obama administration, and the generally unpublicized efforts by hospitals involved, mean that an unknown number of migrants have been involuntarily and “voluntarily” deported/removed despite the accepted principle of Federal preemption in the regulation of migration.

News Round-up (12/5/09)

Sarah S. Willen
SMU

As the U.S. Congress wrestles with President Barack Obama’s proposal for system-wide health care reform, “illegal” immigrants’ overwhelming lack of health insurance coverage has become a matter of heated national debate. The debate erupted full-force in September when Representative Joe Wilson’s (R-SC) interrupted President Obama’s presentation of his health care plan before a joint session of Congress. In response to Obama’s declaration that unauthorized immigrants would be excluded from the planned reform, Wilson issued his now-infamous accusation of the President: “You lie!” This highly publicized breach of Congressional etiquette, and the media frenzy that ensued, say much about how American politicians, and the American public, think about unauthorized im/migrants’ health.

Illegal Immigrants as the Last Frontier of Welfare – Didier Fassin

 

Didier Fassin
Institute for Advanced Study, Princeton

This is a note of circumstance in two ways. First, it was written as the prelude to a lecture on “Global Health” delivered at the Conference of the Society for Medical Anthropology at Yale University in September 2009; it must therefore be placed in this broader perspective. Second, it refers to a scene I found significant in the early period of the debate around health care reform in the United States. However, I do not want to be seen as following the crowd of critics of this courageous and indispensable reform always deferred. Thus this fragment must be considered simultaneously within this specific context and outside of it, since it is meant to evoke the larger question of which members a society may exclude from its solidarity (and I refer here to “members” because people who live, work and die in a given society can claim membership whatever their citizenship and status).

Health Care Reform Is Intimately Linked to Immigration Reform – Peter Guarnaccia

Peter J. Guarnaccia
Rutgers University

As a long-term advocate of universal health care, I am cautiously optimistic that current bills will make a positive difference for many. But as someone who has rapidly become more involved with transnational Mexican communities and their health issues, I am dismayed by the current refusal to include unauthorized immigrants in the health care plan.

In preparing our book, A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship (2006), Keith Wailoo, Julie Livingston and I organized two conferences to discuss issues of organ transplantation, Latinos in the U.S. health care system, and rights to medical care. I came to this project amazed that Jesica Santillan, an 18-year-old undocumented Mexican immigrant who had come to the U.S. explicitly to try to get a heart-lung transplant, had managed to receive such a procedure.

“You Lie!”: Going Beyond the Obama-Wilson Debate – Josiah Heyman

Josiah Heyman
University of Texas at El Paso

Representative Joe Wilson famously interrupted President Obama’s health care speech to Congress by shouting “you lie,” just after the President had said that proposed legislation would not provide access to health insurance for undocumented immigrants.  Factually, Wilson was wrong.  The legislation indeed restricts the undocumented from receiving its benefits.  But the central assumption of the debate itself is wrong.  Obama claimed that a rigid line had been drawn; Wilson that it was not rigid enough.  But on close examination the rigid line fades from sight.

In public health, our fates are connected.  The H1N1 flu is a mild reminder of this.  When there is a more severe pandemic, we will regret frightening off and making access hard for any of our biological neighbors.  To offer a different, but I hope even more persuasive angle: health care access is a matter of mutual moral obligations, a network of ties accumulated throughout society.  I know a 100-year-old woman, still in good health but needing a bit of attention.  She herself is an immigrant, a citizen and retiree after years of marginalization and hard labor.  Her caregiver is undocumented, undergoing the same life of sweat and stigma in the present day.  They owe each other their existence.  They depend on each other for their health.

Immigrant Health: Shamans, ‘Soul Calling’ and the Uninsured – Jennifer Hirsch & Emily Vasquez

Jennifer S. Hirsch & Emily Vasquez
Mailman School of Public Health, Columbia University

What a bitter irony to read about hospitals’ growing willingness “to consider patients’ cultural beliefs and values.”  In “A Doctor for Disease, a Shaman for the Soul” (September 19, 2009) the New York Times describes the integration of Shamans and their traditional healing practices, including “soul calling” and chanting, at a hospital in Merced, California, that serves patients from a local Hmong community. The program, meant to build understanding between the Hmong and the medical establishment, exemplifies an approach “being adopted by dozens of medical institutions and clinics across the country that cater to immigrant, refugee and ethnic-minority populations.”