Reader response: Immigrant dialysis story stirs anger, debate

This week we published a story, taken from a Las Vegas daily, describing how the area's big charity medical center spends $20 million a year on dialysis services for illegal immigrants. (The immigrants end up there because they've been referred by for-profit hospitals, naturally...)

As part of the article, your editor noted that while paying attention to medical costs is good, focus on a comparatively small cost as a function of healthcare system costs might do more to focus resentment on the immigrant community than get at systemic causes of cost for the uninsured of all types.

Well, as I expected, my correspondents were more concerned with the immigrant status of people involved than looking at how we cope with the reality that a) these people are here, and b) solving their problems is a step toward solving the problems of the uninsured generally.

A few samples  of the numerous letters FierceHealthcare received:

"It's all nice and fuzzy to think that the U.S. can provide free healthcare to everyone independent of immigration status, but the reality is, as the public is finally recognizing, that the piggy-bank only holds so much money and both federal and state governments have a primary obligation to protect and care for it's legal citizens before contemplating providing such benefits to other non-U.S. citizens. Any healthcare reform that includes anyone other than legal U.S. citizens will be an open door to illegal immigration floods, as well as further alienating our nation of legal hardworking taxpaying citizens."  - Pharmacist
"Does it mater if it's a drop in the bucket or half a bucket? Illegal immigrants should be returned to their country of origin for medical care. Why should I pay for their health care (through taxes)?"  - Clinical pathology manager

"The costs of care for procedures such as dialysis do appear at first glance to be like a "drop in the bucket", but each drop adds to the total volume and in California where I reside and work, the bucket has been swamped , we are flooded, and the state nearly bankrupt. I have always felt that ultimately, when it comes to the care of pregnant women, their infants and children, the LONG-TERM benefits of care outweighed the costs. We of course comply with EMTALA at my hospital, and my nursing colleagues are the strongest patient advocates for women and infant rights that I have ever had the privilege to work with. But as the stream of illegal people coming to our hospital turned into a "massive river", it was obvious that we would soon run out of money and we have." - Clinical professor of nursing

As is obvious from this and other articles we've run, people's political and personal passions run deep on this subject, so we intend to keep delving into the issue of how to manage care for immigrants as part of political reform. If nothing else, looking at how we handle the most difficult to pay-for issue is critical in thinking about how we manage the whole. I thank everyone for their comments and look forward to engaging with you further. - Anne