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Comment by ThomPete | Hacker News Reader

Here is the problem. How do you deal with illegal immigrants? At least in the current system there are ways for them to get treated, but in a single payer system?

Single-payer works great in countries were everyone have a ssn. Not sure its feasible in the US as much as i think it would be great.

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By giving them healthcare? There aren't actually a large number of illegal immigrants sitting around contributing nothing to the CA economy.

A lot of them even pay taxes with stolen SSNs!

its not that easy. Once you have a single payer system suddenly you need to follow a budget. You now have to put limits on how many can be treated, for what, what kind of treatments and machines you have budgets for. Thats the thing with healtcare you can never spent enough on it and that alone will affect the willingness to pay for others.

I did a quick search and an estimated 11 million illegal immigrants pay an estimated $11.6 billion in taxes, so $1,000 per person.

It's a huge net loss. Not to mention the fallout from stolen SSNs and creating demand for stolen SSNs

When I worked a minimum wage job after high school full time I paid zero in taxes, and I'm a citizen.

We're not counting working illegally, "under the table".

Even (legal) minimum wage workers pay full FICA and Medicare tax.

You're making an incorrect assumption that taxes paid are proportional to GDP contribution. Do you really think that, for example, low-paid migrant farm workers contribute correspondingly little to economic output? They contribute hugely to farm output!

As an extreme example, unpaid workes (slaves in places and times with slavery, interns, etc) still contribute to their employers' output. The right thing to do isn't to reduce their rights and benefits to be commensurate with their nonexistent salaries; instead, their rights and benefits (and hence taxes) should be increased to be (at least) commensurate with their value to the economy.

The stolen SSN issue is a bizarre strawman. There's a trivial solution: give them real SSNs.

You just treat them like anyone else and the cost gets rolled into the cost of coverage for everyone. Hospitals and ERs are already required to treat people who come in regardless of whether they are legal/illegal or have/don't have insurance. So... we pay for their (and citizens who can't afford their coverage) care anyways. With single payer that cost would just be spread across everyone in the state rather than spread across only people with insurance.

In a single payer system thats not going to work. Keep in mind that you don't make money anymore you have a taxpayer paid budget. Thats not going to leave room for that.

That they are required to treat is even worse for a budget it wouldnt hold long.

I do not understand your argument. You just price a new tax high enough such that the system is paid for, no? I think everyone agrees that you need a new tax to pay for the system, and you are not going to take the current tax revenue and pay for single payer plus everything else the government pays for. Instead of paying for insurance premiums or getting a lower salary because health insurance is part of your compensation, you would just pay a new tax. As a result your life would be simplified since you no longer would need to worry about insurance networks, levels of coverage, out-of-network doctors in in-network-hospitals, etc.

in the real world you dont just do that. The problem is that you can never pay too much for healthcare so how much tax you are going to pay is important.

The US is a big and complex country, its not like other countries and so you run the risk of having to tax so high to make it sustainable that its dead on arival.

>How do you deal with illegal immigrants?

You deport them? Doesn't seem like a big problem.

Deport them or not, but after treating them, because healthcare is a basic human right. Definitely a non-problem compared to a healthcare system that is incenticized to profit from the sick rather than prevent long-term health issues and keep the population healthy as a whole.

How does this stop illegal immigrants getting treated the same way they do now?

You can pay out of pocket. The second you get into free healtcare you need to suddenly track things on federal and state level to make sure budgets are kept. I am a fan of single payer but its a very different beast and i am not sure its possible in a US context.

Oh ya, Illegal immigrants totally pay their medicals bills after going to the emergency room.

Most countries just deny them public healthcare in the first place. You know, like happens already in the US right now.

The US system is more complex than that. There are plenty of illegal immigrants who get treated in the healthcare system today. As long as you have money you can get treated. In a public healthcare system you have to be identified as legal citizen in order to get access to the system. The system are going to have quotas of how many people are allowed to get treated with what etc. How do you think the general taxpayer is going to react to that?

It's as simple as you try to make it sound like.

So, right now, they have to pay out of pocket. With a public system, they can also pay out of pocket. So no difference.

I don't know why Americans pretend that a public heathcare system necessarily means the sudden end to all private services overnight. Here in Australia you're more than welcome to have your own private insurance or pay out of pocket for treatment.

The number of illegal immigrants in the US is around 11 million.

Healthcare is one of the most expensive posts in any society. The US system is not built for single payer model which means many other areas will have to change too.

What normally happens when you make a public healthcare system and allow for private enterprise (which I am a fan of having) is that the primary burden (cancer, long term illness, major surgeries) are put in the hands of the public hospitals while the private ones deal more with things like cosmetic plastic surgery and other treatments which are lucrative.

Most public healthcare systems with a single payer model have to heavily prioritize how man can get treatment, for what, with what kind of technology etc.

It's not just a matter of switching from one kind of insurance model to another it's about turning hospitals into places who can't make money but have to adhere to a budget. It's a very very different kind of system that comes out of that and in a country like the US with that many illegal immigrant I am not sure it can work financially.

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