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Healthcare debate must include costs for treating illegals

The civil case against a Florida hospital draws to a close this week. A relative of an illegal alien sued Martin Memorial Medical Center when it repatriated the man after treating him for nearly three years at an un-reimbursed cost of $1.5 million. The relative/legal guardian wants an unspecified six-figure judgment for alleged false imprisonment and nearly $1 million in economic damages for the medical care he has not received since 2003. That’s when Martin Memorial paid $30,000 to charter a jet to take Luis Jimenez to a medical facility in Guatemala. Jimenez now lives with his mother.

Carol Plato, the director of corporate business services for Martin Memorial in Stuart, says Jimenez is an example of what happens when hospitals treat illegal immigrants. Martin Memorial also is treating an illegal Mexican immigrant for severe brain damage. The man has no family in this country. He’s cost Martin Memorial about $1.5 million over the past two years. Plato says Martin Memorial has contacted the Mexican consulate and the U.S. government about returning the man to Mexico, but no one’s helping.

In addition to this patient, Plato says six illegal immigrants use Martin Memorial three days a week for dialysis with no reimbursement because of their status.

Listen closely, but you’ll be hard-pressed to hear anyone in Washington, from the White House to Capitol Hill, placing medical coverage for illegal immigrants as a priority in the healthcare debate. They don’t want to address it seriously, because then they’d have to find a solution to the overall problem of illegal immigration.

Uncompensated costs to hospitals and other healthcare providers run into the billions of dollars annually. The Florida Hospital Association estimates that in 2007, treatment for illegal immigrant patients cost $100 million. A 2004 study by the Federation for American Immigration Reform put California’s annual cost at $1.4 billion.

States bordering Mexico take the biggest hits. A study by the United States/Mexico Border Counties Coalition found that hospitals serving the 24 U.S. counties along the border ate $190 million in the year 2000.

The Emergency Medical Treatment and Active Labor Act requires all emergency departments to treat all persons coming in seeking medical care, regardless of residency status or ability to pay. Hospitals cannot legally ask residency status of patients, which thwarts attempts to determine accurately the scope of the situation.

A few years ago, the U.S. Government Accountability Office looked for available federal funding to help hospitals offset the costs of treating illegal immigrants. GAO surveyed 503 hospitals and interviewed Medicaid and Medicare officials in ten states, only to determine that an accurate assessment of these uncompensated costs “remains elusive.”

Conservative estimates place the number of illegal immigrants in the U.S. as high as 10 million. Nearly 60 percent of the illegals do not have health insurance, according to the Pew Hispanic Center. That means 40 percent have health insurance, mostly provided by their employers. If that’s the case, then around 4 million illegal immigrants receive health coverage because they’ve supplied their employers with false or stolen Social Security numbers.

Here in Texas, the state and local hospital districts spent about $677 million on uncompensated health care for illegals in FY 05, according to the Texas Health and Human Services Commission. The Harris County Hospital District provided $203.5 million in uncompensated care, according to the study, which hospital district administrators say is twice what they really lost. The study, however, did not include figures from the University of Texas Medical Branch in Galveston, which lost $140 million a year, according to published reports.

“Last year, 6,540 visits from undocumented immigrants cost Parkland Hospital System in Dallas $7 million, and Memorial Hermann in Houston incurred over $4 million in cost for their care,” says Kay Bailey Hutchison (R-Texas). “Hospitals in Connecticut, Delaware, Florida, Louisiana, Nevada, and other states have drawn 100 percent of the available federal aid to help defray the costs associated with providing care for illegal immigrants.”

Unless Congress comes up with a way to fix the illegal immigration problem, the continued strain on the healthcare system by undocumented individuals will cut into any cost savings of a universal healthcare plan.
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Memo to Obama: Laughter no substitute for leadership

President Barack Obama’s performance on “The Tonight Show” last week prompted various friends and colleagues to discuss the question of leadership. No one came up with a definition suitable for nailing to the wall or turning into a message to scroll across the computer screen. I suggested it may be one of those things we know when we don’t see it. Kinda the reverse of former Supreme Court Justice Potter Stewart’s description of hard-core pornography. He knew it when he saw it.

And that’s the curious, if not tortured, parallel between lack of leadership and porn: with both, someone’s gonna get (fill in the appropriate verb).

I used to work closely with the CEO of a billion-dollar research and education organization with thousands of employees spread out over several locations. Looking back over his tenure, I can break down his leadership style into four principles: 1) don’t make me make a decision, 2) give folks what they want, 3) make people feel good, and 4) make them laugh. I guess you could combine the third and fourth tenets to shorten the list.

Early on, the CEO told his vice presidents not to bring him any problems. “I expect you to work them out,” he said. “If you come to me for a solution, I figure the best minds here couldn’t come up with an answer, so you’ll be stuck with whatever I come up with.” 

Shortly after that, a group of downstream managers asked permission and funding to continue an annual management conference. “I had the same sort of request at my last place,” he told me. “I always let them do it, because it takes them about a year to organize one of these things, and that keeps them away from me for a year.”

He never spoke in depth on any subject, because, as I discovered, he didn’t possess any depth of knowledge or experience. But he was awfully good with smoke and mirrors. “I don’t use prepared speeches,” he told me. “I got about six or seven basic speeches I like to use, and I use a little of one here and a little of another there, to come up with something to say. I usually don’t know what I’m going to say until I get up there.  But it’s important to know that people don’t want to think hard about things and they don’t want to hear bad news. You want to give them just a few statistics to keep the subject fresh, and tell them a little history to give them some perspective on what you’re talking about.”

And then came his request of me. “I need you to find me some new jokes,” he said. “I spend about half my time finding jokes. So, you could do me a big favor by finding some new jokes for me.”

President Obama’s appearance with Leno made me look back over the past year and at the parallels with the aforementioned CEO. Let’s start with decisions. We’ll have to give the president the benefit of the doubt here and assume someone else is making the big decisions, like naming tax cheats to his cabinet, or picking a treasury secretary who was butt deep into the AIG bonus fiasco from the git-go. Those must have been examples of “If you come to me for a nominee, I figure the best minds here couldn’t come up with a good choice, so you’ll be stuck with the person I choose.” 

Next is give folks what they want. People wanted change going into the November elections. Every national poll last summer showed nine out of ten Americans did not like Congress’ performance, while eight out of ten didn’t like the president’s performance. The voters wanted change, and that was the mantra repeated by candidate Obama at every stop. It didn’t matter if the change were cosmetic and easily reversed when needed, like with John McCain’s assertion that the fundamentals of the economy are sound, a position derided by candidate Obama as a statement by someone out of touch with the realities of the American people. Then a few days ago, a bright light shone from the heavens and suddenly the fundamentals of the economy are sound. Praise the Lord and pass the ipecac.

Then came the I’m-just-one-of-you evenings with Leno, with Mr. Obama as the sole guest on a night that could have included an enhanced starlet, a stoned rocker, or a kid who whistles Chopin through his nose. No, we didn’t have one of those. Pity. I’m not sure even the most vapid of entertainers would have made fun of the Special Olympics just so folks could feel good and laugh.

Memo to President Obama: Laughter is no substitute for leadership.

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Don't underestimate race and trust in choosing a president

When historians look back on the 2008 U.S. presidential election, they may determine race and trust were the silent and deciding factors in the surprise election of John McCain.  Those same historians may also conclude Barack Obama played a significant role in his own defeat by making race an issue and by eroding the trust of voters by refusing to place his faith in them.

Let’s begin the race issue with a disclaimer.  I looked hard at the Obama candidacy early on, because I didn’t find much in common politically with the choices at the time.  Except for Obama.  We’re both from Illinois.  We’re both racially mixed.  Neither of us conducted our youthful days in conventional ways, at least not conventional to people of earlier generations.

But, before I went Full Barry, I wanted to hear him repudiate those who could not resist the easy temptation to call him the black candidate.  I waited for him to say his father was a black man from Kenya and his mother was a white woman from Kansas, which made him the new, blended face of our nation.  I wanted to hear him say he was not a hyphenated American, because that simple mark dividing races and nationalities also divides our people as a nation.

Instead, he encouraged his followers and confederates to carry his African-American status like a battle flag to rally the troops.

I considered myself an equal mix of Anglo and Chinese until my wife pointed out this week, “Obama’s more of a white man than you are.”  After blinking my eyes a few times, I asked what she meant.

“Think about it.  Your father was part Native American.  Duh.”

I thought about it, and she was right.  My mother is full-blooded Chinese, my father was around a quarter Native American, so that makes me less than 40 percent Anglo, or white.  And (if you’ll pardon my grammar) that makes the black candidate for president more of a white man than me.

Obama’s choice to play the race card may not be lost on a sizeable portion of the non-black electorate.  Some folks already mention the Bradley Effect, which says a decisive number of people just can’t bring themselves to vote for a black candidate, regardless of what they say or do leading up to Election Day.  The name comes from former Los Angeles mayor Tom Bradley, a black candidate who lost his 1982 California gubernatorial bid even though he led in pre-election polls.  

And today, less than two weeks from Election Day, it’s easy to understand why some non-black voters don’t want others to know they do not support Obama.  Who can blame them when any criticism or questioning of the candidate of change results in immediate old-school accusations of racism?

And that brings us to the second factor, the issue of trust.  Obama never really condemns the past and current political views of fellow Chicagoan Bill Ayers, pointing out, instead, that Ayers’ terrorist activities occurred when Obama was 8 years old, and, therefore, have no connection to Obama today.  If that’s true, then Obama’s position negates the argument of some black people who push for reparations because their ancestors were slaves.  That’s because slavery occurred before those living today were born, and, therefore, has no connection to anyone today.  Unless, of course, we have people who believe in slavery, in segregation, and in the superiority of one race over another.  If so, then we can make an argument that those who pal around socially, politically, or professionally with such individuals must share some level of affinity.

But Citizen Obama does not fully trust the American people to know his full and true relationship with Ayers, because he does not trust the American people to look at his life and accept him as our president.

The American people knew George W. Bush grew up around such neo-con luminaries as Don Rumsfeld and Dick Cheney, but we elected him twice to the presidency.

The American people knew Bush was an average college student, and at one time was what some would call a drunkard who even lost his driver’s license for drunk driving, but we elected him twice to the presidency.

The American people knew Bush was an unsuccessful businessman and person not glib or quick on his feet, but we elected him twice to the presidency.

The American people only know about Obama what Obama wants us to know.  And mistrust in the judgment of the American people may tip enough votes to McCain, a candidate the American people know well.

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