Sympathy and Exclusion

Sympathy and Exclusion

Definition of Sympathy and Exclusion:

The United States has, for a very long time, dealt with the issue of healthcare access for undocumented immigrants and the extent to which these people experience exclusion from medical treatment or resources, or sympathy from the American public, more localized populations, or philanthropy. Sympathy, in this context, can be defined as the feeling by some Americans that everybody in need of it should be able to access the care they need (especially children, who are the epitome of innocence). This proliferates in society through local benevolence or philanthropy as well as national or private charitable networks that give people the resources they need to access care. Exclusion, on the other hand, can be defined as the social views and policy that bars undocumented immigrants from receiving the care they need. This proliferates in society through stereotyping, isolation of the immigrant population into specific communities, framing of undocumented immigrants as enemies that take jobs and resources, and policy that excludes immigrants from both basic and complex health needs.

Historical Context:

The historical tension between exclusion and sympathy dates as far back as 1920, when the government established separate public health clinics for Mexicans (even citizens) and Americans (Hoffman 2006, 239). Migrant farmworkers had very little access to healthcare until 1962, when the Migrant Health Act allowed these people to get correct immunization against diseases often found where they worked (Hoffman 2006, 239). This attempt at inclusion, however, was somewhat empty, because many undocumented immigrants were reluctant to attend clinics due to fear of deportation. Exclusion was augmented in 1973, when undocumented immigrants were specifically excluded from Medicaid (Hoffman 2006, 242). Even some legal immigrants were eventually restricted access to healthcare after the Immigration Reform and Control Act of 1986, which reduced undocumented immigrants’ chances of finding jobs with health insurance coverage (Hoffman 2006, 242). While some states sympathized and sought to try to include these people in their healthcare systems, these attempts at inclusion generated legal debates and confusion.  This problem is still very evident today, and as recently as 2003 over 69% of primarily Spanish-speaking Hispanics were lacking health care coverage (Hoffman 2006, 244). Also, non-citizens only have access to 5% of organ donations, and realistically receive much less than that (Hoffman 2006, 244). Today’s policy gives undocumented immigrants access only to Emergency Medicaid.

More information on issues for immigrants under Trump’s government: (https://www.statnews.com/2017/02/24/immigrants-doctors-medical-care/)

Relevant Examples of Sympathy vs. Exclusion Debate: 

The first example of sympathy against exclusion in the United States regarding healthcare access for undocumented immigrants is the case of Jesica Santillan, who received two sets of organs for transplant after medical malpractice resulted in problematic outcomes for the first surgery. At the center of this debate was the idea that as an undocumented immigrant, Jesica was robbing true Americans of precious medical and financial resources (in this case organs and donations)(Hoffman 2006, 238). This exclusionary perspective, however, did not win in Jesica’s case. Sympathy for child innocence prevailed in her effort to gain access to resources in care, as fundraising efforts as well as political support and generosity from Duke University granted her access (Hoffman 2006, 237-238).

In another example, Jacinto Cruz and Jose Rodriguez-Saldana were transported to an Iowa hospital where they were both comatose from a car accident. Despite having health insurance from their work, both men were Mexican undocumented immigrants in the United States. Despite needing the care, the hospital made the decision to fly the patients back to Mexico, deporting them without talking to the federal government. In the last 5 years, this has occurred at least 600 times (“U.S. Hospitals Deported Hundreds of Immigrants” 2013). Hospitals are not obligated to care for a patient who is undocumented after they are in stable condition (“U.S. Hospitals Deported Hundreds of Immigrants” 2013), so some patients are sent back to their home countries in potential need of further care in the U.S. (that they do not receive until they are home).

Example of the deep flaws in America’s immigration and healthcare systems: (http://www.nytimes.com/2008/08/03/us/03deport.html)

Contributors and Opinions in the Debate (Controversy/Perspectives):

The controversy of the debate has one side where sympathy highlights the idea of ethically caring for people who are in need (despite their legal status in the country), while the other side highlights the notion that as non-citizens, treating these people wastes valuable finances and resources for healthcare. The reality today is that undocumented immigrants have very limited access to care. In his article “Illegal Immigrants, Healthcare, and Social Responsibility,” James Dwyer frames the debate in the perspective of nationalists against humanists (Meslin 2006, 258). On the nationalists side, undocumented immigrants receiving care are free-riders on American taxpayers, and do not deserve care (exclusion)(Meslin 2006, 258). On the other side, humanists argue that undocumented immigrants are functioning social members of society; therefore, they should be granted access to care (Meslin 2006, 258). Moreover, many citizens are not law abiding, and the same goes for undocumented immigrants, but still many are contributing positively to society. Dwyer provides a third perspective that somewhat builds off of the humanist argument, that socially and ethically it is the American responsibility to treat those people that are social members of society that are harmed, sick, or injured in the country (Meslin 2006, 258). Politicians, lobbyists and activists, and the public in general are completely divided over whether sympathy or exclusion is the correct policy for treating undocumented people, but trends in federal policy suggest that access to care has continually become more limited to the undocumented population (Hoffman 2006, 238).

Relating to Politics of Health:

The sympathy and exclusion debate links to the politics of health in many ways, but is linked heavily with structural violence, especially against the non-national, immigrant, and undocumented immigrant populations. In American society, immigrant populations have been historically excluded, especially the undocumented immigrant population coming from South America or Mexico. The stereotyping, isolation of these people into specific regions or communities in the country, and government policy regarding medical deportation and care for these populations is inherently exclusionary. This inequity translates into difficulty in gaining access to care, thus exposing the reasoning for the populations’ troubles with access to care, but not revealing a strategy to improve this situation. This culminates in a structural violence against these populations needing but not having care.

Citations:

Dwyer, James. “Illegal Immigrants, Health Care, and Social Responsibility.” Hastings Center Report 34, 1 (2004): 34-41

Hoffman, Beatrix. “Sympathy and exclusion: access to health care for undocumented immigrants in the united states.” In A Death Retold, 238-54

Eric M. Meslin, Karen R. Salmon, and Jason T. Eberl. “Eligibility for Organ Transplantation
to Foreign Nationals: The Relationship Between Citizenship, Justice, and Philanthropy as Policy Criteria.” In A Death Retold, 237-254

“Report: U.S. hospitals deported hundreds of immigrants.” CBSnews. April 23, 2013