Immigration And Health Care Debates Merge

President Barack Obama has repeatedly been pressed to defend his plan to overhaul health care. And for many, one of the biggest points of contention is whether undocumented immigrants will have access. Host Michel Martin talks to Jennifer Ng'andu, Deputy Director of the Health Policy Project at the National Council of La Raza, and David Rosner, Professor of Sociomedical Sciences at Columbia University.

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MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

Coming up, H1N1 hits the Ivy League. More than 500 students at Cornell University are ill. We'll find out how they're doing in a few minutes. But first, we've been talking about the issue of offering health care to illegal immigrants. This has become a flashpoint for conservatives who insist that a health care overhaul must explicitly bar the undocumented from access to benefits.

If you remember this is the issue that sparked Representative Joe Wilson's outburst in the House last week during the president's speech. His colleagues last night voted to sanction him for it. But now we want to ask whether illegal immigrants should have access to health care?

Joining us now to talk about this is Jennifer Ng'andu. She's deputy director of the Health Policy Project at the National Council of La Raza. That's a Latino civil rights group. And David Rosner, he's a professor of history at Columbia University. He is considered the nation's foremost - one of the nation's foremost scholars on the history of health care in this country - who gets access to health care and why? Thank you both for joining us.

Ms. JENNIFER NG'ANDU (Deputy Director, Health Policy Project, National Council, La Raza): Thank you so much.

Professor DAVID ROSNER (History, Columbia University): Nice to be here.

MARTIN: Jennifer, let's start. Why should the government give access to health care to undocumented immigrants? I'm sure you heard our two previous guests who say that it's immoral to offer access to health care to people who are here illegally.

Ms. NG'ANDU: Well NCLR believes that this is the only common sense solution to health care reform. We need as many people paying into the system and getting good health care to ensure that we drive our health care costs down. It only makes common sense.

MARTIN: Why does it only make common sense?

Ms. NG'ANDU: That everyone should share in the responsibility. This helps to strengthen public health, drive health care costs down and ultimately strengthens the health care system.

MARTIN: You also believe that there's a moral issue here as well - if you would give us that aspect of your perspective.

Ms. NG'ANDU: Well, we absolutely believe that there's a moral imperative especially to cover all children in this country. People should have access to health care in order to ensure their opportunities and ensure that they have stability and security - something that the president addressed in his speech.

MARTIN: But from a practical standpoint, I mean, you can - you can understand the argument against it. People say if you're here illegally, you have not followed the rules of the country. Every country has a right to protect its borders. Why should someone who has not followed the rules have access to a benefit? And you just say it's common sense. Why is it common sense?

Ms. NG'ANDU: Well, the one thing that I'll say about this is that we will never be effective at weeding out everybody who is accessing this system. And what's happening now is that we're touting measures that will put red tape and bureaucracy in the way of health care of U.S. citizens and legal immigrants. This is something that's going to affect you and me, not - not necessarily the undocumented immigrants that everybody is talking about.

This fault line drawn by Joe Wilson and touted by the president, quite frankly, is going to put barriers between millions of Americans and their health care.

MARTIN: Professor Rosner, I must say I am fascinated by your work.

Prof. ROSNER: Thank you.

MARTIN: …because you have been - thank you for the work. But you have been studying the question of how we have historically in this country decided who should have access to health care and why. If you'd just tell us a little bit about that. It's - it's my understanding that - that you believe that there has always been sort of a moral judgment implied on who should have access to health care.

Prof. ROSNER: Yes, unfortunately the moral aspects of who deserves and who doesn't deserve or who is worthy or not worthy of health care has been deeply embedded in the American health system literally from 19th century on. We've established public hospitals for the poor. We've established private hospitals for the wealthy or the better off, private insurance for some, public insurance for others. Even in our public policies we see embedded a set of moral judgments about who is quote, "worthy individuals," that shows how deeply, you know, deeply divisive this issue of who deserves and who doesn't deserve care.

MARTIN: But why do you say that there's been a moral judgment involved? I mean is there a perspective about sickness that has kind of ruled our - our judgment about who should have access to care or not, that if you're sick you deserve to be here or something like that?

Prof. ROSNER: Well, exactly. The - from our very early history, even in the 18th century, we've always acquainted being well with being the moral person or being healthy with being a moral person, being sick especially with certain kinds of illnesses as being a judgment of God of our unworthiness. So, we've seen, you know, judgments about our own responsibility or sense that when we get sick it's probably due to something we ourselves did.

We still ask questions about whether or not someone smoked who has cancer or did something or drank when they get liver cirrhosis. We still see judgments about who gets AIDS and who doesn't that are really kind of moral judgments, not necessarily medical or epidemiologic judgments.

MARTIN: And - and how does the question of - of offering access to health care to illegal immigrants play into the way we have historically viewed this issue?

Prof. ROSNER: Well, from the very beginnings of our hospital system, for example, we've always brought in our nativist ideas, our ideas about the immigrant and the person from the outside as the bearer of bad news, the bearer of disease. We talk about, you know, disease coming from overseas, the Hong Kong flu in the past or, you know, or SARS coming from Asia or even the West Nile virus.

We try to find ways of saying, we as a moral country are really immune from disease because we have our, you know, our long traditions and our upstanding nature and we're a democracy. And it's really other worlds that bring in disease to us. So, we have - we blame the Haitians for the AIDS epidemic in the early '80s. We put them in actual camps because we suspected them of having disease and bringing it to ourselves. So, we've always - we've always tried to argue that somehow those who are healthy, when they get sick are getting disease because of others, sort of the activities of others.

MARTIN: But you know, other countries have nativist sentiments too but they still cover people out of status, who are out of status, I mean refugees, immigrants from, you know, people criticize the sort of the European model but the fact is they also have nativist sentiments but they also extend health care to people. So, what's the difference in your view in attitude…

Prof. ROSNER: Well I think…

MARTIN: …(unintelligible). I'm going to get back to you too.

Prof. ROSNER: I'm sorry. I think in general in the European cultures there's been a very important countervailing force to the kind of nativist instincts, and, you know, first of all you have a strong labor movement in many - many European cultures. You have a Labor Party in England. You have strong socialist movements even and social-democratic movements throughout Europe that are a countervailing force to the kind of the conservative, you know, backward-looking nativist fear of who is coming into your country.

So I think that, you know, the histories of individual countries all have balances that we in the United States unfortunately have never really had.

MARTIN: Jennifer, if I could get back to you. You work for La Raza, which is as we have said is a civil rights organization dedicated to Latinos. You are not Latina, but can I ask you, you are the daughter of immigrants. Did you have a story about access to medical care that in part informs your perspective on this?

Ms. NG'ANDU: Oh, absolutely, I think getting to the focus of health care, which is what this is really about, there are many different people who've had these experiences. This broken system of health care is really about an American problem. And so me, myself and I have experienced the delays in care and, you know, being in a low-income family I've had barriers to health care that have resulted in poor outcomes.

I shouldn't have to have Strep throat for a month before I can go to the doctor. And quite frankly, that's the experience of so many people these days. And so if we keep the focus on health care and ensuring that we have a strong system, then we ought to be looking at how we get as many people in.

MARTIN: But how do you - but how do you get over the hurdle of those who simply say that if you don't follow the rules, you don't get access to the same level of care or benefits that the people who did follow the rules get? How do you -how do you address that?

Ms. NG'ANDU: I think we should look at what we're talking about here. One of the proposals on the table is telling people that they can't buy their own health coverage at full price. That is a - a direct threat on our public health and people ought to be able to share in the responsibility of paying for their own health care. So, we think that people need to look at the practical aspects of this in the common sense and that is how we're going to strengthen our health care system.

MARTIN: Professor, can I - can I ask you to step away from the history for a second and just get your perspective on the question of whether illegal immigrants should receive access to care or not and - and why, if you think that they should?

Prof. ROSNER: Sure, I mean the - the most obvious practical reason is apart from the general morality of it that we can't let people die on the streets, and if we have something that can help a human being live we should be providing just out of our basic humanity.

But on the other level, it is really a basic problem in public health when you try to turn public health workers and physicians and health care workers into the police force. And when we start thinking about trying to govern a system in which thousands of people are coming through the system, and we're going to be the police force, what it means is we're going to create tremendous distrust among that population. And we're going to find that people who actually have communicable diseases, for example, will not be going to us, not going to public-health officials for their care and which means that we don't know where the disease is.

One of the basic functions of public health is really to follow disease, to make sure where we know where it is so that we can stem epidemics. And this is a situation in which we're building a case for cutting off our noses in order to spite our face, so to speak, that we're trying to set up bureaucracies and establish a whole new way of providing health care that ultimately is going to harm us. It is going to create a system where we'll never know where the next H1N1 outbreak will happen or SARS or monkey pox or West Nile Virus.

MARTIN: Given, though, how deeply entrenched the attitudes among many Americans are, particularly given the historical roots of them, do you really believe that perspectives on this may change?

Ms. ROSNER: Well, I think that's what the whole health care debate is about right now. I think that there's been a, you know, an unfortunately very heated partisan debate. But, basically, we're talking about our responsibilities as a nation. And you can see that the idea of universal access, of having a guaranteed access to health care, is something that's deeply felt by millions and millions of Americans, but this is something that's a basic human right.

And so I don't think all is hopeless, and I think the Obama administration is trying as best it can to kind of navigate the difficult, historical, you know, breakdown in our society between those who just really have a direct antipathy to anyone who's different and others who are trying to create a country out of many, many groups.

MARTIN: Jennifer, final thought from you. Given the intensity of discussion that we've heard around this issue, do you see any sign that perspectives are moving in your direction?

Ms. NG'ANDU: I would just ask people to think about the marginalization of the community and what that means for them. Ultimately, isolating these communities will have impact in keeping other Americans and their families away from health care that they need.

MARTIN: Jennifer Ng'andu is deputy director of the Health Policy Project at the National Council of La Raza, she was kind enough to join us here in our Washington, D.C., studios. David Rosner is the Ronald H. Lauterstein Professor of Sociomedical Sciences and professor of history at Columbia University. He was here with us from our NPR studios in New York. Thank you both so much for speaking with us.

Mr. ROSNER: Thank you.

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