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

[FireStarterRN]

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.

[HM2VikingRN, RN]

Yes, I was thinking the same. Nurses work their tails off for their benefits, and pay hefty co-pays as well. Those who pay into the system pay more than their fair share, since they also pay tax dollars which pay for the medical indigents, plus their own insurance premiums.

And how many nurses continue to work fulltime merely to keep their health benefits, often at the expense of their own physical and mental well-being?

You just made the case for a true single payer system.

[Djuna]

In all honesty the most demanding, entitled patients I have worked with are refugee claimants. They expect this country to give it all to them.

I have to agree with this comment Fiona. Both in New Zealand and Australia we have the same problem with refugees using the public health system as their primary health care provider and having such a attitude about their rights that they become obnoxious and very difficult to deal with.

I am in two minds on the subject. On one hand I object to people who have never paid into the system making full use of it, however as long as these people are legitimate, legal residents, it is their right to be provided with free healthcare.

The problem with free healthcare in NZ, Australia, UK, Canada etc, is the blatant and profligate abuse. The problem with a user-pays healthcare system is those who cannot afford it don't have their basic needs met.

There is no easy answer at all. As a RN who works in ED I have to put aside my political and philosophical stances and just treat all people equally. It's easy to get bitter. I choose every day not to allow my prejudices interfere with patient care.

[FireStarterRN, BSN, RN]

As has been stated, the term "medical indigent" is a legal definition, and that is how I was using it. A medically indigent patient is one with no resources to cover his/her medical expenses.

[HM2VikingRN, RN]

leslie,

the thing is, that socioeconomic status and health status are inextricably intertwined. the very people we label as "non-compliant" are the same people who are impoverished. statistically speaking, those with means are healthier. so, it is a catch-22.

how many elderly people on medicare do we see come into the acute care setting with chf or copd exacerbations because they were "non-compliant", when it turns out that "non-compliant" means that they stopped taking their meds because they could not afford them? they had to choose between eating and taking their pills.

we can do better at helping patients manage chronic illness. the american prospect had an excellent article a few months ago that described a better approach to illness management.

problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications. moreover, many health problems don't lend themselves to bargain shopping. it's a little tricky to try to negotiate prices from an ambulance gurney.

a wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. the french have addressed this by creating what amounts to a tiered system for treatment reimbursement. as jonathan cohn explains in his new book, sick:

in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government limits every individual's out-of-pocket expenses.

in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.

the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.

at http://www.prospect.org/cs/articles?article=the_health_of_nations .

there is no blaming in this article. rather i think we need to ask how can we as a society do better in helping patients manage chronic illnesses.

(undoubtedly a comprehensive antipoverty strategy would do wonders in helping to reduce the ravages of chronic illness as poverty is the number 1 risk factor for poor health.)

[FireStarterRN, BSN, RN]

Sorry, but this nation has spent billions on anti-poverty programs. Unfortunately, there is no government answer to the spiritual poverty that accounts for 80% rates of out-of-wedlock births in some communities. The social breakdown in America today leads to many of these problems, and anti-poverty programs have not alleviated that over the years.

[Djuna]

That was a really interesting article Viking.

[shelly304]

I reside in one of the largest welfare states in the US.

In my county it is accepted to:

*Drop out of high school.

*Get pregnant before the age of 18. Because the parents refuse to let the school board instill the teaching of birth control or make birth control available. (Our churchs do not want our young people to have BC readily available) My county had 46 pregnant girls this school year alone-that does not count the under 18 population that have dropped out of high school.

*Not work. Because you can stay on your lazy butt, collect welfare, get state healthcare. Always. Forever.

Before anyone wants to pass judgement on me for writing this please understand, I do know that in times of our lives we may need help. That is what gov't. assist. is for. But where I live, government assistance is a WAY OF LIFE for so many people. And it is generational.

I see this every day in the clinic I work in.

Recently I needed to hire someone to help care for my livestock. 4 horses. A woman applied for this physical, demanding, lift 100lb. haybales, feedbags, fence mending, stall cleaning, and driving a tractor position! She had recently moved here from another state to take advantage of the healthcare-welfare offered in my state.

She did let me know she preferred cash under the table so not to jeopardize her free ride. Nope, sorry. I pay taxes, I get taxed,

thanks but no thanks I will hire someone who does not insist on scamming the system and contributing to what is already so very, very wrong!

[HM2VikingRN, RN]

I could pick any government program and find people using it who are not "eligible" in the legal sense of the word. The key is to fix the problems within programs not throw out the whole system.

My point about poverty was not meant to start a debate on these programs. Rather it was to reaffirm the very real data that shows that poverty is a root cause of poor health.

If we are truly interested in addressing some of the causes of these issues at their root we will need to think about how to restore access to the middle class.

I encourage anyone who is interested in some of these issues to read:

[HM2VikingRN, RN]

Also:

at http://www.conservativenannystate.org/cnswebbook.pdf

[Vito Andolini]

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". my thoughts exactly.

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?

don't forget the doctors who also smoke, drink to excess, and carry around huge guts. no one is immune, it seems, to self-harm. be it from depression, poor time management, whatever, so many of us don't take good care of ourselves.

for the op: what exactly did the nephew say that made you think the uncle was here only for the free health care? and here's another way to look at the whole thing: the uncle worked here, probably did not get social security taken out of his terribly low, cash wages, so did not get the employer contribution of that ss, and did perform some service here, as opposed to being on welfare. now he's on welfare, it seems. is it totally right? no. totally wrong? no. life is unfair. is he out robbing and pillaging? no. at least he worked.

is it fair when people who have never even worked here come to america and receive social security, meal and rent subsidies, free medical care, and low interest loans to start businesses that americans can only dream of receiving? our legislators are giving away the whole country. who's telling them to do it? that's the real and deeper question.

[Vito Andolini]

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?

So what are we going to do about this?

[Vito Andolini]

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.

That is really messed up. Makes you wonder if foreigners who marry Americans really love them. No insult intended to your father and his wife, and I do wish them every happiness, but I just can't help but wonder.