Immigration and National Health Care

Ryan Avent argues that failing to include illegal immigrants in a national health care plan is shameful:

We’ll treat an immigrant kid with tuberculosis, because we don’t want him infecting our American kids, but you know, we’re not about to acknowledge the basic humanity of people who are enduring many hardships to give their families a better life, just as the ancestors of most of the population of America did.

This whole health care mess is enough to make a man lose his faith in people.

Derek Thompson (from whom I found the above) concurs:

Again, I'm with Ryan all the way morally. I think every person in America deserves health care. I think it's an issue of morality, of human rights. And immigrants are people, too.

I realize that few readers of the DR are both (1) in favor of immigration limits, and (2) in favor of national health care. But those are probably both majority opinions on the left, and so I hope someone here can explain this to me.

Here's my question, and I mean it in a completely non-snarky, honest-inquiry way: How can it possibly be the case that by breaking the law of a country, one acquires a claim against its inhabitants?

Consider: Virtually no one would argue that American taxpayers have an obligation to pay for the health care of a Nicaraguan in Nicaragua[*]. But if that person comes to the United States illegally, then apparently it becomes an obligation of Americans to care for him.

So what is it that the illegal immigrant has done that suddenly entitles him to my taxes to pay for his health care? Thompson thinks he deserves health care because he is "in America". But if health care is a "human right", then surely it belongs to the Nicaraguan while he was in his native land.

Maybe it's because the illegal immigrant contributed to the economy here? But I don't see how that can be the case. Suppose the person had remained in Nicaragua as a farmer exporting his entire crop to the United States. Then he is economically linked with Americans just as the immigrant is, but few argue he is entitled to health care.

Now for something like a communicable disease, then one rationale for providing health care would be naked self-interest. But I don't see how that applies to something like cancer or heart disease.

And I think it violates many (most?) peoples' sense of propriety to reward people for breaking the law, even if they don't agree with it. I spoke to several people during the immigration debates of '06 who were outraged about the amnesty proposal despite being in favor of continued (and even increased) immigration. They just did not think it was right that someone from India who had trouble keeping his visa (to take one example I know of) got nothing out of the amnesty, while someone who came here illegally did. And I have very strong sympathy for that viewpoint. Even if you think bad laws should be disobeyed, does it then naturally follow that legal advantages should accrue to that person? That is very odd to me.

So, I'm posing this question to Avent, Thompson, or anyone else who holds positions (1) and (2) above: Suppose there are two brothers in Nicaragua. Brother A illegally comes to the United States and gets cancer. Brother B stays in Nicaragua and gets cancer. Why should I pay for Brother A's chemo and not Brother B?

I'd like to avoid a discussion here of the morality of immigration restrictions and national health care, if possible. I'm saying that taking those as given, why should illegal immigrants here get preference over, say, those who stayed in their native countries?

[*] I'm going to use Nicaragua as a random example of a foreign country from whom many immigrate illegally to the United States here for concreteness sake, but I do not intend to stereotype.

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Possibly an Obligation of Citizens

One way to look at it would be that it has nothing at all to do with the brothers from Nicaragua. Instead, it might be an obligation of Americans, and American doctors in particular, to provide care to whomever presents themselves for it.

I have no reason to believe that this is something people believe. But it fits with the scenario where American is obligated to treat the brother who illegally enters the country, but not the brother who stays behind.

Interesting answer, thanks.

Interesting answer, thanks. I don't think that's really what's going on here though. I've never heard supporters of national health care talk about a "duty to provide care" or some such, as opposed to a right to health care.

Food for thought, however.

You analyze this as if people are thinking coherently...

...about political matters, or even desire to.

Mostly they're just pushing around piles of emotional mush which they have no intention of justifying.

What is it the citizen has done?

"So what is it that the illegal immigrant has done that suddenly entitles him to my taxes to pay for his health care?"

Nothing, but how does that distinguish the immigrant from a citizen?

As I said, for the purposes

As I said, for the purposes of this question, I'm granting the premise that citizens are entitled to health care.

I'm not looking for a gotcha or to convert them to libertarianism; I'm genuinely curious as to what left-liberals believe about this.

Granting the premise on what basis?

I don't see how you can credibly require a rationale from your opponent without offering one for your granted premise.

I think their defense often goes something like this: If there is an badly injured man on the road in front of your house, most people would agree you have a moral obligation to assist him. In part the obligation exists simply because you are there. This is not an obligation which extends to seeking out and assisting injured individuals wherever they may be on the planet - people in close proximity bear more obligation.

This is not an intellectually rigorous defense, and I reject it out of hand for several reasons, but it is sufficiently compatible with common intuitions to pass as an emotional explanation, which is quite sufficient for most people.

If you think you're going change the political views of a typical liberal, or a typical conservative or libertarian for that matter, with logical "gotcha" then you're really wasting your time.

Most people hold their political views based primarily on predispositions and prejudices. There is a psychic cost to modifying their views and rarely any political payoff whatsoever. It simply doesn't pay for most people to think rigorously through their political views, and it actually makes sense for them to retain irrational political views.

I don't see how you can

I don't see how you can credibly require a rationale from your opponent without offering one for your granted premise.

It's a hypothetical; I don't have to offer justification, and I'm not going to. If you don't want to grant the premise, then fine, the question is not meant for you. I'm aiming at those who do grant it. And your explanation for those who do is quite interesting to me anyway, thanks for it.

If you think you're going change the political views of a typical liberal, or a typical conservative or libertarian for that matter, with logical "gotcha" then you're really wasting your time.

I agree completely. When I said "I'm not looking for a gotcha", I in fact meant I was not looking for a gotcha. I'm not looking to argue nitty-gritty philosophy with people; I find that stuff tedious.

Most people hold their political views based primarily on predispositions and prejudices.

I agree with that too, but the human mind is remarkably good at constructing arguments for what we intuitively want to believe. I happen to be interested in those.

"It's a hypothetical; I

"It's a hypothetical; I don't have to offer justification, and I'm not going to."

Then what's wrong with this answer: Because citizens have no greater entitlement to public health care than immigrants.

That's a true statement. And given the premise you granted - that citizens are entitled to health care - it follows as night the day that immigrants are entitled to health care.

That's the problem with the premise you granted. You gave away the point.

BTW, I misread your initial comment about "gotchas", sorry for the mistake.

Your premise is flawed.

Your premise is flawed. There isn't anything like the same fervour for immigration restrictions on the left as there is on the right. Those who believe on a right to healthcare tend to have a reasonably liberal attitude towards immigration. Where there is more of a contradiction is when it comes to trade. I'd wager there's a much closer correlation between protectionism and national healthcare advocacy than there is with immigration restriction. Also on the "duty to provide" issue, you'll probably find that this is generally conflated with the "right to" in the minds of those with an interest in national healthcare.

It's true that people on the

It's true that people on the left are somewhat more favorably disposed towards immigration than those on the right. But the effect isn't as large as you suggest. I can't find any results broken down by ideology, but here are some by party, an imperfect proxy. The percent of Republicans who want more immigration is 11%, Democrats 15%. I have no idea what percent are in favor of truly open borders, but I'd be willing to bet it is no more than 5%.

So I don't think that solves the puzzle. It seems pretty clear from this that a majority of people who support a national right to health care not only support some immigration restriction (no open borders), but actually support stricter limits.

Now Avent is not one of those people; he wants more immigration. But even he admits he wants some restriction:

I understand the there are some good reasons to oppose a complete open door policy toward immigration. There are limits to the number of new people America can absorb in a short period of time. But given the massive net welfare gains to immigration, we should be erring on the side of letting too many in rather than too few. Frankly, I think America has a long, long, long way to go before we need to start worrying about whether we’re being a little too open to immigrants.

So he holds the positions that
(1) some people will want to come to the United States, but will not be legally allowed to
(2) if someone violates that law, they are entitled to health care, but
(3) if someone obeys that law, they are not (I'm assuming he's not proposing a global right to American health care)

And I remain puzzled by this.

Universal healthcare

A better footnote:

* - some people would argue that it is the duty of the American Taxpayers to provide health care to the guy in Nicuragua. You will find these people praising the work of the UN and saying disparaging things about how the average American consumes ten times the resources of the rest of the world put together.

I have no problem with people contributing to charities, and I think that when one has extra money they should give, but the government should not force people to donate, and one should decide themself what is extra money.

Brink Lindsey & Dan Klein

Brink Lindsey & Dan Klein have taken Paul Krugman to task for endorsing immigration restriction for fear of inequality. I'm not much of a liberal, so I don't find it a very telling point. The more people denied state-benefits the better.

I don't think you have to be

I don't think you have to be a liberal to find the tension between open immigration and welfare statism telling. If one of your goals is to weaken the welfare state, then you should be pointing out this tension to every liberal (and non-liberal) you come across. Wouldn't you prefer if people like Krugman responded to this tension by embracing open immigration and rejecting the welfare state, rather than the other way around?

This is what I've never understood about conservative and libertarian opponents of open immigration. Why are they concerned with keeping the welfare state sustainable? Do they not realize that the less ethnically homogeneous the nation, the less support there is for redistribution?

I don't want to "heighten

I don't want to "heighten the contradictions" so it collapses. Worse is not better, worse is worse. Even the Soviet Union, one of the worst governments in history, evokes nostalgia on the part of many Russians (Stalin in particular) because the collapse was so awful, while Putin is loved for turning the clock back. The French monarchy would seem upsetting to many libertarians, but when they were overthrown the result was Jacobins and then Napoleon running things. Same deal with Kaiser Wilhelm to Hitler and Tsar Romanov to Lenin. Liberals/progressives are not simply afflicted by false consciousness when they praise Scandinavia to the skies: for all its faults the area is a nice place to live. They'd be better without a welfare state, but a well-run welfare state ranks pretty high in world-historic terms. A two-tiered society looks like Latin America.

Diversity may make whites more opposed to welfare, but that means less and less as they become a smaller fraction of the population. You can't wait for a time when they've shrunk just enough to cut-off immigration, because natural increase will continue to result in their fraction shrinking.

I don't expect Krugman to reject the welfare state, and I've written about how I don't think the ideas of intellectuals matter.

No where in my post did I

No where in my post did I suggest immediate and sudden collapse. I mentioned "weakening", which can be charitably interpreted as gradual change.

Diversity may make whites more opposed to welfare, but that means less and less as they become a smaller fraction of the population.

Where do you get the idea that diversity only makes whites more opposed to welfare? My understanding is that diversity makes every ethnic group opposed to welfare. This is one of the benefits of ethnocentrism (perhaps the only one) - people are less likely to support redistribution from what they perceive as the in-group to the out-group.

Dpes diversity only make whites more opposed to welfare?

I decided to investigate the issue further. My suspicion is that as long as ones own group is a receiver of welfare payments while other groups are payers, support will continue.

This is what I've never

This is what I've never understood about conservative and libertarian opponents of open immigration. Why are they concerned with keeping the welfare state sustainable? Do they not realize that the less ethnically homogeneous the nation, the less support there is for redistribution?

No, I don't think they do realize it. At least, I didn't think about it myself for a long time, and I think I know more about politics than the average American.

It's a somewhat counter-intuitive conclusion for most people, I think, because minority groups tend to be more left-wing, so the "natural" conclusion is more minorities ==> more redistribution, although empirically that seems to be wrong, as you know.

Nice coherent argument

I think you made your point effectively and clearly. But then perhaps I would say that; I agree with you!

I'm British but I'm quite interested in the American healthcare debate. Were I an American I would be in favour of national health care, but only for citizens.

I can understand the sentiment though, that says that, healthcare should be provided to illegal immigrants as they are people too. Hell, it would be _nice_ to provide free healthcare to the entire world, but sadly there just isn't the money to do it.

I could understand if the intention was to let the illegal immigrant stay in the country though. - If their children will be citizens then it would be bad to turn them against the state. But if you are going to let them stay, why are they still illegal immigrants?

I like your site

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