Foreign patient with greencard only staying in U.S. for 'free' medical care

[FireStarterRN, BSN, RN]

Basically, I really love my Spanish speaking patients in every way. I'm talking about people born and raised outside of the United States. They have Old World manners, respect for elders, I love their family values. They really are great, and Americans can learn a lot from their old fashioned ways. I love the way they roll up their sleeves and care for their hospitalized family member.

I had a gentleman in his 50s, totally Spanish speaking, had been a farm worker but with too many health problems to work, most of which resulting from IDDM non-compliance leading to heart problems and renal insufficiency. Most of his family was back in Mexico, including his 7 (grown) children. He spoke very little English.

His nephew came in, he spoke English, he was nice as can be. He wanted to know more about what was going on, he gave me more background info. His Uncle had a greencard, wasn't able to work, had wanted to go back to Mexico but was only staying for the free medical care.

Ha ha, 'free medical care', I thought. . I think most Americans would disagree with that statement. I guess it is free for non-citizens with no means, and for other dirt poor people, but it's not really free, is it? It's really, actually, expensive.

Meanwhile, his uncle, who was very polite, appreciative, nice, was also irresponsible. According to the H&P he had been mostly non-compliant with his meds and treatment plan.

I think there is a disconnect in our system. There is very little personal accountablity. There is lots of talk about Patient Rights, and very little talk about Responsibilty. I'm not just talking about non-citizens who consider the U.S. the land of free medical care, but I'm talking about a system that rewards irresponsiblity.

If we ever get socialized medicine, I seriously doubt if the government will have the backbone to build in any system for accountability into it. I see people abuse their bodies to the point that they are unable to work, then expect the taxpayer to pick up the tab for their medical care, for life, while they sit back and complain what victims they are. I see this over and over again. It's a huge problem in America today, with no solution in sight.

[Virgo_RN, BSN, RN]

There but for the grace of God go I. Managing diabetes can be like a full time job in and of itself. And yet we expect these people with very little means, education, and support to do so, and if they are unsuccessful, we label them "noncompliant".

Of all people who know better, how many nurses smoke? How many eat fast food on a regular basis? How many choose to sit in front of the TV rather than go to the gym?

[BlueRidgeHomeRN]

i see people abuse their bodies to the point that they are unable to work, then expect the taxpayer to pick up the tab for their medical care, for life, while they sit back and complain what victims they are. i see this over and over again. it's a huge problem in america today, with no solution in sight.

:redbeathe:yeah::redbeathe

couldn't have said it better. everyone has rights, no one has any responsibilities--not even to or for themselves.:angryfire:angryfire:angryfire

when it comes to able bodied adults..

"if one does not work, either shall he eat...":no:

(said in a pretty important book a long time ago..)

[BlueRidgeHomeRN]

of all people who know better, how many nurses smoke? how many eat fast food on a regular basis? how many choose to sit in front of the tv rather than go to the gym?

so you think this situation is just fine???

just another poor totally innocent "victim" in a nation of victims...

[FireStarterRN, BSN, RN]

I don't know how else to label non-adherence to treatment recommendations. The official term seems to be 'non-compliance'. As we all know, it's a common occurance that leads to chronic, debilitating consequences.

I think our society soft-peddles individual responsibity too often. Instead, we expect 'them' to offer us a quick fix. It's like homeowners who build in a flood plain, then expect the Federal Government to provide them with disaster relief when the inevitable storm hits.

[Virgo_RN, BSN, RN]

so you think this situation is just fine???

i think it is what it is. i don't get worked up over it.

just another poor totally innocent "victim" in a nation of victims...

that was an uncalled for personal attack. i do not smoke, i eat a diet rich in plant foods and low in saturated fat, and i am physically active. why? because i believe in taking responsibility for my own health. does that sound like i see myself as a "victim"?

[FireStarterRN, BSN, RN]

I don't think that statement was directed at you, Nancy Nurse. I interpreted it as a general statement.

[Multicollinearity, BSN, RN]

To me, this is a huge ethical problem. Many working US citizens doing their very best cannot get health coverage, and then we look at this patient who gets "free medical care." It's just too much.

I may sound cold, but I think after emergency stabilization, he should be deported if he is a non-citizen and cannot get coverage or pay for his care. It's just too much of a slap in the face to hardworking citizens who have unmet needs themselves.

[Virgo_RN, BSN, RN]

I don't know how else to label non-adherence to treatment recommendations. The official term seems to be 'non-compliance'. As we all know, it's a common occurance that leads to chronic, debilitating consequences.

I think our society soft-peddles individual responsibity too often. Instead, we expect 'them' to offer us a quick fix. It's like homeowners who build in a flood plain, then expect the Federal Government to provide them with disaster relief when the inevitable storm hits.

Oh yes, I agree with you. As a former dog trainer, I have seen the desire for the quick fix again and again. People would rather slap a shock collar on their dog to make them obey than to take the time to learn about learning theory and build a relationship of trust with their companion.

I guess my point is, that this is human nature, and fighting it is like swimming upstream.

How I handle it on a professional level is to facilitate self efficacy, point it out and reward it when I see it, and in those situations where it is not forthcoming no matter what I do, just accept it instead of banging my head against a brick wall.

[FireStarterRN, BSN, RN]

To me, this is a huge ethical problem. Many working American citizens doing their very best cannot get health coverage, and then we look at this patient who gets "free medical care." It's just too much.

I may sound cold, but I think after emergency stabilization, he should be deported if he is a non-citizen and cannot get coverage or pay for his care. It's just too much of a slap in the face to hardworking citizens who have unmet needs themselves.

I totally agree. I think it makes citizenship valueless when hardworking Americans are subsidizing non-citizens in this way, yet leaving our own people lacking access to basic care.

[Multicollinearity, BSN, RN]

US policies regarding public benefits and non-citizens are kinda strange to me. Here's an example of what I mean.

My father is a US citizen. He recently married a Canadian citizen. They spend six months of each year in the US and six months in Canada.

After a waiting period, the US government began paying his wife Social Security retirement monthly because she is his spouse and Medicare because she is over 65. She is not a dual-citizen. She never worked in the US or contributed to our system in any way.

On the other hand, the Canadian government will provide zero benefits to my father as a non-citizen. They will not cover him on their Medicare system or give any kind of public retirement benefit. Nothing - from the Canadian government for a non-citizen. Yet the US government just doles out so much in benefits to a non-citizen who never lived in the US or contributed taxes in any way.

I think the Canadians have the smarter fiscal policy.

[FireStarterRN, BSN, RN]

Oh yes, I agree with you. As a former dog trainer, I have seen the desire for the quick fix again and again. People would rather slap a shock collar on their dog to make them obey than to take the time to learn about learning theory and build a relationship of trust with their companion.

I guess my point is, that this is human nature, and fighting it is like swimming upstream.

How I handle it on a professional level is to facilitate self efficacy, point it out and reward it when I see it, and in those situations where it is not forthcoming no matter what I do, just accept it instead of banging my head against a brick wall.

That's where I believe our medical system needs to step in and demand individual responsibity with systems in place.

Another example from yesterday is a prisoner whom I had as a patient. He was a manipulative, disgusting individual who considered his hospital stay a chance to be waited on hand and foot, until the guard stepped in and laid down the law for him on call light usage.

He was just starting cancer treatments, on top of all his other health problems (he was in his 70s).

Yep, free healthcare in America today, for non-compliant foreigners and aging prisoners! Meanwhile, let's cut back on benefits for our young men and women returning from Iraq! And, forget about helping blue collar workers without health benefits!

I ask you, do you think our priorities are mixed up here?