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News Round-up (12/5/09)

Sarah S. Willen

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.

As Didier Fassin and Josiah Heyman argue in separate posts on this blog, the Obama-Wilson exchange reveals a fundamental, taken-for-granted assumption that shapes the thinking of the majority of Democrats and Republicans alike: that unauthorized migrants’ health needs are not the problem of the public, or the U.S. government, or the American people. One core objective of ACCESS DENIED is to subject this assumption to rigorous and sustained critique.

Several recent commentaries on Slate.com raise precisely the sort of question we hope to engage on the blog.  In “The Nativism Tax,” Timothy Noah contends that “Wilson’s nativism has added $4.3 billion to the cost of health care reform” by obligating taxpayers to absorb (or, more precisely, to continue absorbing) costs that unauthorized im/migrants could themselves cover if they were included in the proposed reforms. Legislators, Noah contends, “are literally denying uninsured illegal immigrants the opportunity to pay for their own health care by purchasing health insurance.” An earlier Slate.com commentary by Christopher Beam published last summer advances a similar argument. According to Beam, “If you think insuring the uninsured makes economic sense, then so does insuring undocumented immigrants. But neither side in the health care debate seems eager to make this point.” Indeed, Beam writes, “[p]olitically, insuring illegals would be disastrous. … But if Obama wants to make the purely economic case for health care reform, it seems odd to reject a potential source of savings.”

Ongoing feature coverage in the New York Times raises similar questions about the relationship among citizenship status, social contracts, equity, and ethics.  Several recent articles examine the closure of the outpatient dialysis clinic at Atlanta’s Grady Hospital, which served for years as a “fragile lifeline” for unauthorized immigrants with kidney disease but closed in October leaving its patients in crisis and without life-sustaining dialysis care. Another recent piece – critiqued on this blog by Jennifer Hirsch and Emily Vasquez – explores new efforts to integrate traditional healers into biomedical treatment at U.S. health care institutions that cater to immigrant, refugee and ethnic-minority populations.

These feature articles – like the NYT’s earlier pieces on hospital-initiated deportation of chronically ill patients and on the lack of health care options for unauthorized immigrants in the U.S. who fall ill or become injured – raise complex and provocative political, social, and ethical questions. The goal of ACCESS DENIED is not to grope around for quick or easy answers. Rather, our aim  is to foreground, critically assess, and struggle with the questions.

Sarah S. Willen, PhD, MPH is Assistant Professor of Anthropology at Southern Methodist University and a founding member of the ACCESS DENIED blog team.

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