February 19, 2007

Memo From Mexico, By Allan Wall

Why Mexican Hospital Emergency Rooms Aren’t Swamped

Emergency rooms in American hospitals are being overwhelmed by uninsured patients who don’t pay for medical care, as my VDARE.COM colleague Edwin Rubenstein has pointed out in several articles (see here and here). A significant portion of these patients are immigrants, often illegal aliens.

The complicating factor is a law known as EMTALA (Emergency Medical Treatment and Active Labor Act of 1985) which forbids emergency rooms from refusing service to anyone, regardless of ability to pay.

This has resulted in ERs being swamped by patients who must be treated for free, including illegal aliens. And not only illegal alien Mexicans in the U.S. In a brazen display of chutzpah, Mexicans who live on their side of the border are taken by ambulance to hospitals on the U.S. side, where they know they can’t be refused.

So not only does our federal government refuse to control the border, it also makes hospitals treat illegal aliens for free.

Did I say free? I meant free for the aliens—not for the hospitals, some of which are going out of business.

Of course, what the government should do is charge the cheap labor profiteers who hire illegals for both medical care and the costs of deportation.

How do they handle this in Mexico?

Well, as a resident of Mexico, I’ve been to Mexican emergency rooms a few times—as a visitor, as a parent, and just recently, as a patient myself.

When my elder son was twenty-two months old, he fell and cut his head. So my wife, mother-in-law and I took him in our Volkswagen to a private hospital emergency room. The boy had his noggin stitched up and was as good as new.

It wasn’t free though. My wife paid with a credit card before we departed the premises.

Just a few months ago, I developed a painful case of colitis, an unpleasant condition I hadn’t even known about until I had it.

The pain was so bad my wife took me to the nearest private hospital emergency room, where they hooked me up to an IV (the first time in my life I’d had that experience). They had to pump a lot of painkiller into me, and mix up some kind of potent IV cocktail to finally bring the pain down.

Before we left, my wife paid with a credit card. The good thing is, I didn’t have to spend the night, or it would’ve cost more.

No free medical care for me.

Now if I’d been thinking ahead, I could have tried to make a test case out of it. I could have tried to get emergency medical care for free, on the grounds that Mexicans get free emergency room care in the United States.

Somehow though, I don’t think they’d have bought that argument.

Wherever you go, medical care has to be paid for somehow. In Mexico there are various ways.

Rich Mexicans have any medical care they want, some of them even fly to Houston for it.

Middle class Mexicans can avail themselves of private sector medical care, which is reasonably priced.

Then there are various government-sponsored health insurance plans. The biggest is Seguro Social, which includes all private sector employees in the formal economy. I’m enrolled, but I’ve never used it.

The self-employed and workers in the informal economy aren’t automatically included in Seguro Social but can join the program and make the payments.

For government employees, there’s a different program called ISSSTE. The oil monopoly PEMEX has its health program for employees, the military has its program. In all of these employee-based programs, the employee’s paycheck is deducted to contribute to the fund. So they’re not free to the user either.

For Mexicans without health insurance, there’s a new program called Seguro Popular. To join this program, one must pay for it, except for those under a certain income level, who get it for free.

In addition, there are various medical facilities operated by charities and churches.

Americans residing in Mexico are generally either gainfully employed or financially independent (because that's the way the Mexican government wants it). So Americans either pay out of pocket for private care, or pay for a Seguro Social policy, or a combination of both. If a foreigner enters the Seguro Social he’d better be ready to have his Mexican immigration papers checked.

The urban area in which I reside has a number of hospitals and clinics, both public and private. Most ER care is paid for either out of pocket, or by one of the health insurance plans mentioned above. In the case of a car accident, the patient is taken by ambulance to whichever hospital is appropriate for his economic situation. Those who are indigent and can’t pay anything usually wind up at the Red Cross hospital, where, if they prove they can’t pay anything, they can get free care.

Interestingly enough, there is something superficially similar to EMTALA in Mexican law—Article 36 of the Ley General de Salud. [Word Document] It stipulates that health care providers, public or private, must charge Mexicans in accordance with their socioeconomic level and even exempt them if they are unable to pay.

As for foreigners who come to Mexico for the primary purpose of receiving medical treatment (as some do), they must be charged at the full rate, except in cases of emergency. [A los extranjeros que ingresen al país con el propósito predominante de hacer uso de los servicios de salud, se cobrará íntegramente el costo de los mismos, excepto en los casos de urgencias.]

(And Mexican hospitals absolutely will turn foreigners away if they are unable to pay cash up front. “I was negotiating with them. It was like a barter. We were bartering back and forth. They wanted $20,000 US. They said, I'll take $10,000 US. It's like going to a flea market and you are playing with somebody's life here”, said a Canadian woman recently. Her husband ultimately died from complications following a heart attack in Puerto Vallarta, after the travel insurance he had purchased in Canada was denied on a technicality. (One family's nightmare with travel insurance, Kathy Tomlinson, CTV News, Dec. 14 2006.)

One major reason Mexican emergency rooms are not being overwhelmed by uninsured patients, as they are in the U.S.A.: they are still emergency rooms. They are only used for emergencies. And physicians, not patients, determine what an emergency is.

In contrast, the EMTALA regime in the U.S.A. will slap a $50,000 fine on a hospital for refusing treatment, even if the attending doctor determined a case was a non-emergency.

Combine that insane policy with open borders and you’ve got a real disaster on your hands.

When I think of an Emergency Room, I think of victims of car wrecks and things like that. But under EMTALA, the patient decides what an emergency is. So nowadays, "emergencies" also include a cough, a headache, or a hangnail, because the patient says so. Drug and alcohol addictions are considered emergencies. So is a favorite malady known as "permanent disability", which includes social, mental and personality disorders (i.e. it could be almost anything). It entitles the patient to eligibility for SSI (Supplemental Security Income).

Once again, shouldn’t the employers of illegal aliens be paying for all this?

Before her untimely death last year, Dr. Madeline Pelner Cosman summarized the situation under EMTALA:

"The definition of emergency is so flexible and vague enough to include almost any condition. Any patient coming to a hospital ED (emergency department) requesting ‘emergency’ must be screened and treated…whether or not insured, ‘documented’ or able to pay… High technology EDs have degenerated into free medical offices. Between 1993 and 2003, 60 California hospitals closed because half their services became unpaid."[Dr. Madeline Pelner Cosman, "Illegal Aliens and American Medicine", Journal of American Physicians and Surgeons, Vol. 10, Number 1 Spring 2005, PDF]

Here in Mexico, the hospitals don’t put up with such nonsense, and physicians, not patients, still call the shots.

Of course, any attempt to change or scrap EMTALA, can be expected to meet howls of protest from the Mexican government and its meddling diplomats.

Mexico’s leaders are quite happy to use the emergency rooms in the U.S. to absorb medical costs for Mexican citizens. And our leaders are only to happy to oblige.

But they don’t allow the same insanity in Mexico.

So I reckon I won’t be getting free treatment for hangnail anytime soon.