By Marshall Scott
I was one who had waited with great excitement to see the President speak on health care. I will admit to a certain personal stake in what he would say; I am, after all, a chaplain. I am also an Episcopalian, whose General Convention has affirmed again and again, and as recently as this past summer, the Episcopal Church’s support for universal access to safe and affordable health care.
I don’t think anyone will be surprised that I was largely pleased by what I heard. I was also interested in the political theater of the event. There was a carefully choreographed dance of expression and gesture. The supportive Democrats stood and applauded. In those few times when the President explicitly reached out to the Republicans they smiled, if a bit grimly; and they applauded, if half-heartedly. And between those few references they sat, mute, and unresponsive.
All, that is, except Congressman Joe Wilson. The President came to a part of the speech when he debunked false claims that had been made broadly about the various bills being pieced together. And as the President stated that there was no provision in the bills being pieced together for these benefits to extend to illegal immigrants, Congressman Wilson lost control and cried out, “You lie!” I was shocked at the disrespect, both for the moment and for the Office of the President. Those present were shocked and disapproving, in both parties. Perhaps the person who appeared least shocked was President Obama himself. As he has done so often he simply held his calm and returned to his point.
There was certainly outrage at the incident, and under pressure from House and Senate leadership in both parties Congressman Wilson apologized to the President. The outrage even lingered for a while. It was, of course, a perfect television moment, and it was replayed again and again to feed the needs of the 24-hour news cycle.
I was certainly outraged at the event. We have fallen far if anyone, but especially an elected Representative, should show such disrespect for the Office of the President, whoever currently occupies that office. But quickly I was outraged at something else: I was outraged at the opposition to making provision to provide care for illegal immigrants.
In fact we need to make provision for providing health care for illegal immigrants. The most important reason is simply one of public health; and as we face this fall not only our seasonal flu but also H1N1 flu, we should be acutely aware of it. Those populations that don’t get care provide reservoirs, opportunities for viruses and other diseases to flourish and adapt, and perhaps become more problematic. This is not, of course, because the victims are illegal, for citizens and legal residents will suffer in much greater numbers. It is because they are not identified and treated in a timely manner if at all. We have certainly seen this issue in AIDS and in the return of tuberculosis: populations that fear seeking treatment, whether out of shame or fear of legal consequences or simple lack of resources, create reservoirs of disease that put the rest of us at continued risk.
There is also the economic reason to make such provisions. In some numbers we will be providing care in any case. We will not send them away; indeed, we cannot. The laws that have made it illegal to “dump” patients, sending them from one ER to another based on ability to pay, make no distinction between patients who are insured or uninsured, legal or illegal. We make the case often enough that lack of primary care brings patients to ER doors only when the illness become in some way debilitating. Thus, they arrive at the place where care is most expensive, and at the time when their illnesses are more advanced, more problematic, and more expensive. And we cannot turn them away. Of course, we don’t want to turn them away. Certainly, Episcopal and other faith-based hospitals see their missions as providing care to all to the best of their ability, including those who can’t pay. But, there is also the law; and under the law we have to provide assessment, stabilization,
and care as appropriate and as we are able.
So, we will be paying for them. Those who simply wish they would go away seem sometimes to hope we could somehow not pay; as if our not providing health care would somehow encourage them to leave. So, they want no provision; and with no provision, it becomes another reason that providers have to “cost-shift.” We don’t end up paying through a program, so we end up paying through higher expenses elsewhere.
But for us as Christians, the most important reason to provide for illegal immigrants is moral. These are still our brothers and sisters in Christ. They are among “the least of these” in Jesus’ family, and Jesus himself has called us to provide care and support. They are neighbors; and if they are neighbors who make us uncomfortable, with whom some don’t wish to associate, well, neither was the Good Samaritan. We are called to care for them simply because they have need, and because it is the Christian thing to do.
We are also called because it is just. These neighbors are among us, most of them working and working hard, and they should no more be “muzzled” than the ox that treads the grain. Do they take jobs away from others? That’s debatable; but it doesn’t mean they shouldn’t be treated justly for the jobs they do. They participate in our economy, working and paying local taxes and often income taxes, including Medicare and Social Security – taxes from which they can never hope to benefit. At the same time, we benefit, those of us who expect to receive Social Security and Medicare benefits some day. They participate in this economy, and receiving benefits of this economy is just.
But what have faith-based arguments to do, some will ask, with a government program? Is there not separation between Church and State? Well, in fact in health care there isn’t much. Faith-based institutions receive the same Medicare and Medicaid reimbursements that other institutions do. They have the same requirements to meet as employers and providers. They are accountable for the National Patient Safety Goals and for infectious disease reporting in the same way.
And to turn the argument around, the diseases don’t distinguish between people of faith and those who aren’t. Some have suggested that the burden of providing care for illegal immigrants, or of providing universal access at all, should fall to those charitable organizations who include it in their mission. But, all our health is “public.” Illness, like the rain, “falls on the just and the unjust.” We have long said we all benefit when certain risks are shared as widely as possible. We have long structured our insurance that way, including especially our health insurance. And there is no wider base for the risk than all who share in the economy – all residents, all providers, all of us. There is also no wider distribution of responsibility, no wider sharing of sacrifice. Thus, in the face of illnesses that do not discriminate, it is unjust for us to discriminate. And as we would affirm here, justice is a Gospel value.
Congressman Wilson wanted to claim a place among those calling not only for an end of illegal immigration, but for isolation and estrangement of those who are already here. Apparently, obnoxious as it might seem, he has succeeded. His outburst has become the central issue of his reelection campaign, used by both his campaign and his opponent’s to raise funds. And yet, as powerfully as I disagree with his position, I will agree that he has raised an important issue. No, President Obama didn’t lie when he said that no legislation proposed so far allows the benefits of health care and health insurance to illegal immigrants. At the same time, we all understand the truth that they will need health care, and somehow we will provide it. Congressman Wilson is outraged that some how we might provide care to illegal immigrants. I think we should be outraged at Congressman Wilson and his compatriots, because I think we must.
The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.