Any serious exploration of reducing spiralling health care costs has to explore the factor of undocumented immigration. In 2004 it was estimated that the cost of providing health care to undocumented immigrants and their families in California was $1.4 billion, a figure that has certainly risen in the last 5 years. In the context of severe state and federal budget shortfalls, this is an issue that we simply cannot ignore. And we cannot continue acquiescing to the efforts of other nations to outsource the responsibility of providing for the health, housing, education and employment needs of their poorest citizens to the American taxpayer.
A surprising number of people believe that it is the duty of health and human service providers to report non-legal residents to immigration authorities. Under this scenario many individuals would not seek needed medical attention, which would lead to needless death and suffering. Not only is this inhumane, but it's politically impossible.
A humane and fiscally sound solution would be to treat all individuals regardless of their immigration status and simply bill foreign governments for the treatment of their citizens. Everytime we offer tax payer funded medical services to undocumented immigrants we could mail out a bill, along with a letter that stated:
Dear foreign government,
As a humane nation we are committed to providing medical treatment to all individuals, regardless of their immigration status. However, due to our staggering national debt, we do not have the financial capacity to offer quality health care to all of our own citizens, let alone citizens of other nations who have violated our immigration laws. We are sure that you share our belief that it is the responsibility of each nation to care for the health and welfare of their own citizens, accordingly you should have no problem reimbursing us for the cost of the medical treatment that we provided to your compatriot. Failure to do so in a timely fashion will result in: an immediate suspension of all aid and assistance that we provide your government and a halt to all future immigration from your nation. We thank you for your cooperation.
Since it's far more expensive to provide health care in the United States than any other country, this policy would add costs to the many benefits (economic remittances and reduced social welfare costs) that undocumented immigration provides to foreign governments. In addition, it could increase incentives for foreign governments to provide health and human services to their citizens within the boundaries of their own countries. Most importantly, the end result would be reduced expenditures to the already strained American health care system, without relying on inhumane measures against undocumented immigrants. The first instinct of governments is to compel with force and fear, whereas economists looks to incentives.