White House Concedes That "Public Option"--Oops, "Exchanges"--Will Shrink Private Insurance Market--And What About Illegal Aliens?

Here's an interesting item on Obamacare and illegal aliens, from Mike Viqueira, writing for MSNBC First Read, in which the White House concedes that "the public option," now being called an "exchange," would shrink the private insurance market. This is from Viqueira's piece:

The bullet points sent tonight by the White House:

* Undocumented immigrants would not be able to buy private insurance on the exchange. Those who are lawfully present in this country would be able to participate.
* Undocumented immigrants would be able to buy insurance in the non-exchange private market, just as they do today. That market will shrink as the exchange takes hold, but it will still exist and will be subject to reforms such as the bans on pre-existing conditions and caps. [emphasis added]

Now that's quite an admission--"that market will shrink as the exchange takes hold"--first caught by Jeremy Shane, a veteran health care observer. It is not the mission of Serious Medicine Strategy to either expand or contract private health insurance. Instead, the goal of SMS is to expand the capacity of the United States, and the world, to seek and find cures to the diseases that leave us ill, incapacitated, or dead.

But of course, as a practical matter, Serious Medicine must exist on a platform of Routine Medicine. We need a basically healthy and non-bankrupt population to support breakthrough endeavors in Serious Medicine.

And so we all must spend time thinking about health insurance, and how to help make sure that everyone has necessary and sufficient access to Routine Medicine. In which case, the credibility of the President when he says, "If you like your health insurance, you can keep your health insurance," is worth probing. If "the public option," or "co-ops," or "exchanges," really do cause the current private-insurance system to come crashing down, well, that's an issue for all of us.

And yet there's also the stubborn issue of illegal aliens, and whether or not to cover them.

The American left is now having to confront the issue of illegal immigration in the context of health care. For the past few decades, the approved "progressive" position was that we should have open borders, so that America can become multicultural. (The US Chamber of Commerce, speaking for companies and agribusinesses who hire illegals, and who like the downward pressure that illegals put on wages, has always been a silent partner in his multicultural effort.)

Enthusiasm for multiculturalism has been distinctly on the wane since 9-11, but the renewed push for national health insurance has further accelerated a return to the ideal of uniculturalism, in which people of all colors agree to live peaceably in the same territory. And that has put a new emphasis on the value of closing the border against illegals--not only to keep Al Qaeda out, but to make sure that everyone here shares the same basic civic allegiances. In a nutshell, you can't have open borders and a welfare state, because the cost of welfaring the world's population will bankrupt you--unless, of course, you get blown up first.

If progressives want multiculturalism, they can have multiculturalism, by keeping the border open. But if they want national health insurance, then they have to close the border. It's as simple as that. And that's exactly what Froma Harrop, writing for truthout.org, said just this morning. Note that she even quotes the great libertarian economist Milton Friedman(!) to bolster her case:

In their tireless efforts to kill health care reform, right-wingers have fanned fears that it would attract illegal aliens. This sideshow is rather twisted because, actually, the reforms would do the opposite. They would help curb illegal immigration.

Start with Canada to see how this works. Canadians have universal coverage, a big immigration program and almost no undocumented workers. These things are not unrelated. Government-guaranteed medical care is a big reason why Canada doesn't tolerate illegal immigration. No country can long afford a large subclass of poor workers that pays little in taxes and collects full benefits.

To quote conservative economist Milton Friedman, "It's just obvious that you can't have free immigration and a welfare state."

So there you have it: To make Canada-style national health insurance work, you have to close the border.

So where does this leave the current debate in the US? The point's been made that even if Rep. Joe Wilson (R-SC) was wrong to yell out during the President's address Wednesday night--and if Wilson was wrong, then lots of others, were wrong, too--he nonetheless seems to have won the policy debate--the White House and Congressional Democrats seems to have shifted course, going out of their way to enunciate an anti-illegals policy. So Wilson may be getting a thrashing in the MSM, but he seems to have prevailed.

But in the meantime, there's still the issue of who is paying for illegal care. As MSNBC's Viqueira also notes in his "First Read" piece:

Here, the administration also concedes that hospitals would be compensated with public funds for the care of undocumented immigrants.

And here's what the White House said, which backs up Viqueira's summary:

There would be no change in the law that requires emergency rooms to treat people who need emergency care, including undocumented immigrants. There is already a federal grant program that compensates states for emergency room costs associated with treatment of undocumented immigrants, a provision sponsored by a Republican lawmaker.

The fact that, as the White House notes, Republicans have their fingerprints all over these compassion-issues is a reminder of how difficult they are. Here at Serious Medicine Strategy, I have mixed feelings about the issue of providing access to illegals: On the one hand, I don't think that anybody should be living in this country illegally, and such people shouldn't be consuming health care services, especially those provided at public expense--it will bankrupt us, as Friedman and Harrop, from their vastly different ideological positions, both agree.

On the other hand, everybody who is here should have decent access to health care--not only for their sake, but for ours. We don't want people walking around coughing up tuberculosis, for example, or SARS or swine flu. So the answer, therefore, is to have zero illegal immigration and illegal residency--a policy that should be bolstered with a strong and secure fence across the U.S.-Mexican border--and then to properly define the health-access of everyone who is here, by definition, legally.

Unfortunately, this White House does not seem very interested in building up border security.

And there are plenty of people who don't trust the government, especially a government run by Democrats, to keep illegals out of the US, and to keep them out of the healthcare system.

Which is a reason why it is still quite possible that no healthcare bill will get through Congress to the President's desk, this year or next.