We just can’t provide for the entire world

greenspun.com : LUSENET : Current News - Homefront Preparations : One Thread

Joe Guzzardi October 14, 2002

Assembly Bill 1045, which will allow 60 Mexican doctors and dentists to practice among Latinos in California’s poor rural areas has created a stir in the medical profession.

No one questions that many of California’s poorest communities do not have access to enough medical and dental care.

Governor Gray Davis, after signing the bill into law, cited statistics that show one doctor for every 460 urban residents versus one doctor for every 935 rural residents.

Of the two ways to approach the problem, increasing the numbers of doctors or decreasing the numbers of people needing medical attention, A. B. 1045 addresses only the former.

Dealing with the other aspect—reducing demand for services—would be cold and murky water for any politician.

A.B. 1045 deals with only a tiny part of the problem. The three principal players in the debate —the California Hispanic Health Care Association, the California Medical Association and the California Dental Association—agree that there is a shortage of services in the state’s agricultural areas.

Some estimates indicate as many as 6 million working poor Latinos do not receive adequate medical attention.

In fact, California is short on physicians throughout the state. Not long ago, California was a magnet for recent medical school graduates. Now, because of the state’s high cost of living and the general hassle of practicing medicine in the Golden State, fewer doctors are willing to practice here. And since even fewer are said to have the language skills or ethnic awareness to treat Mexican patients, reaching out to Mexico looks like a good idea.

Impoverished areas will benefit from having additional doctors and those new doctors will speak Spanish and understand the Latino culture—viewed as critically important to providing complete care.

To participate under A. B. 1045, Mexican doctors would have to be board-certified in Mexico, take English-language classes and practice under a three-year temporary license.

What the Mexican doctors would not have to do, to the consternation of the C.M.A., is pass the same test that every other doctor practicing in state passes: the United States Medical Licensing Examination. A.B. 1045 backers want a special version of the test administered; the U.S.M.L.E. is unwilling to alter its test to suit a special purpose.

And the C.M.A. urges that the Mexican doctors fulfill the same two-year residency requirements as other international physicians. A.B. 1045 waives the residency requirement.

According to Bob McElderry, the CMA’s associate director of government, a two-tiered health system sets a bad precedent that says ‘Because you’re poor, you don’t get a fully credentialed, licensed doctor.”

The C.M.A. traveled to Mexico and is convinced that the doctors who might come to America would be competent. But the question remains: why not pass the test and remove any doubt?

Beyond medical issues, A.B. raises—or should raise—even more compelling and difficult questions.

If we make exceptions for Mexican physicians to practice in California, then why not do the same for Guatemala, Pakistan, India and China? Of course, California has more Mexicans than other nationalities but there are certainly enough poor Central Americans and Asians to warrant physicians under the broad guidelines established by A.B. 1045.

If A.B. 1045 is good for California, then other border states like Arizona, New Mexico and Texas must be drafting similar legislation at this very minute. Inevitably, more Mexican doctors will be flocking to the U.S. And if history is any judge, those “temporary” visa holders will soon become permanent residents.

Having said all that, the biggest and most complex question remains.

While everyone agrees that medical care should be provided for needy patients, California (and the U.S.) has reached the point where its resources are running out.

Whatever short-term solutions A.B. 1045 may provide, the question of what to do about the ever-increasing numbers of uninsured Mexicans in California should be intelligently addressed. If that trend isn’t halted or reversed, the entire California health care system is jeopardized.

No one in Sacramento has the courage to make that point.

In the U.S., nearly 53% of Mexican-born persons have no insurance; for natives, the corresponding figure is 13.5%. The federal and state taxpayer and health insurance policyholders foot this very significant bill—estimated to be about $25 billion.

Look also at the impact uninsured patients on emergency care in California. In fiscal 2000, California emergency facilities lost $325 million. An additional $100 million in services were provided but not bill for.

Here are more harsh realities: the continued migration from Mexico keeps adding to California’s medical crisis. Some migrants work at menial jobs that ideally should—but do not—offer insurance. But many do not work at all.

The further reality is that a large percentage of Mexicans tapping into the medical care system are in the U.S. illegally.

Rep. Mark Foley, R-FLA. recently spoke of Florida’s catastrophic health care situation and acknowledged the legal and moral responsibility not to turn anyone away. But Foley added that it is “hard for hospitals to stay afloat as they are inundated with thousands of illegal immigrants seeking medical care.”

Proponents of A.B. 1045 make much of the fact that no state money will be tapped for the clinic care programs. But someone pays. And that someone is most often the federal taxpayer.

Short-term solutions, like A.B. 1045, are never solutions at all. And everything has limits, even compassion. The time has come to make sure that health care remains adequate and affordable for native-born and legal immigrants.

We just can’t provide for the entire world.

-- Anonymous, October 15, 2002


Moderation questions? read the FAQ