We Already Insure Illegal Immigrants

Okay, if you missed Wednesday's State-of-the-Health Care address, you missed a fairly vintage Obama speech. High rhetoric, open-handed, appealing to consensus, and dismissive of critics. Yada yada yada. You can read Chris Cillizza's thoughts and get a solid idea.

The biggest thing that has dominated coverage was the unfathomably stupid interjection by Rep. Joe Wilson (R-S.C.), who presumably thought he was in Britain's House of Commons or perhaps a hockey game, and yelled out "You lie!" to the President while he was addressing Congress. You would think that, being from a state where the public officials have embarrassed the population recently, one would get this small tidbit of etiquette correct and stay quiet, but Wilson missed the memo and so shouted out, and then was roundly booed by everyone, and subsequently apologized. It was stupid, of course, because it has let the Democrats make the entire story about him, using him as a stand-in for all of the raving town hall people who feel that lack of information should be no barrier to strong feelings.

What Wilson yelled in response to was a statement by Obama that his health care plan would not insure illegal immigrants. This is strictly accurate, and probably will be completely accurate by the time a bill is passed. The Christian Science Monitor goes into detail about how there is a clause that does not include immigration status on a list of reasons one can be denied insurance. My guess is that that is an oversight, and will be fixed by the time this is over (it's a 1600-page bill, written by a combination of lobbyists, activists and Congresspeople... there are going to be some screwups).

But I wanted to take a minute to remind everyone of something that has been basically absent from this debate: WE ALREADY INSURE ILLEGAL IMMIGRANTS.

When an undocumented worker breaks his leg and goes to the emergency room, then does not pay his bill, what do you think happens to those costs? Do they evaporate? As a proud member of a top-line MBA program, I can assure you they do not. Those costs are submitted to Medicaid, which usually picks up a tiny portion, and then the rest get factored in to the "uncollectable" category, and are used to determine next year's budget. When that budget estimates uncollectables, it assumes those bills don't get paid, so that's just money lost. Money lost must be made up somewhere, and that is (you guessed it) your bill. And that is not just people in the country illegally, it's everyone. It's a little oversimplistic, but we already insure everyone, we just make sure to do it in the most expensive way possible.

In business, we talk a lot about "costing," which is one of those made-up terms for something fairly prosaic. It means we need to know what things actually cost, so that we can make better decisions about them. Whatever else health care reform would do, it would provide for a way to account for those 47 million of people who don't have insurance, won't pay their bill, but still get put on the tab anyway. It's an important thing for us to know, even if the number and process are unsightly.

Oh, and probably fewer of those people would die, too. You know, if you care about that sort of thing.