Last week we wrote about a Vox piece claiming immigration will “help save” Social Security. In truth, if we continue with our current immigration system, Social Security will be less likely to survive than if we substantially reduce overall immigration numbers and implement a merit-based system.
This week we’ll take a look at a recent article published in the International Journal of Health Services, and a news story written about that article posted on the WBUR website, Boston’s NPR station (home of Car Talk).
The journal article purports to show that immigrants, a category in which the study’s authors include illegal aliens, pay more into the health care system than the cost of services they receive. There are many things wrong with their methodology. We’ll concentrate on a few.
First, the authors are making sweeping claims about immigrant and non-immigrant populations in the United States without acknowledging the difference between and the variance within these populations. The demographic profile, including health insurance coverage, is much different for permanent resident aliens than it is for naturalized citizens or illegal aliens, undocumented or otherwise. The latter cohort is much less likely to have health insurance and is much more likely to depend on emergency rooms as primary care facilities. Further, illegal aliens are less likely to seek health care services because they are barred from many federal and state programs that use taxpayer money.
Second the authors use an accounting trick to skew their findings. A longstanding practice for researchers looking to calculate healthcare costs, welfare usage, etc., is to look at households. Here's an example why.
If one were trying to determine the poverty rate in a particular locality, one would use household income, not individual income, since the latter would include children, many of who have zero income, which would skew the result. Likewise, including only adults would skew the result because a person making $60,000 a year and living alone is much less likely to be living in poverty than a single parent with four children with the same income.
By including the U.S.-born children of immigrants in with the children of U.S.-born parents, the study authors are able to significantly reduce the cost to the health care system caused by immigration. Of course, it is technically true that any individual born in the United States gains birth right citizenship, but it is deceptive not to compare healthcare costs by household (U.S.-born headed vs. foreign-born headed), which they could have done. This would have produced a much different result.
Third, the article completely fails to tackle the cost of uncompensated care provided to the foreign-born.
Among the limitations of this study was the inability to accurately assess how much uncompensated care is being delivered to immigrants. We have limited data on expenditures for undocumented immigrants as well as insufficient estimates of possible monetary losses to hospitals and other institutions.
No one argues that estimating these costs is a straightforward task, but if the authors are going to make the outright claim that “Per capita public expenditures were lower for immigrants overall, particularly for the undocumented” then they cannot so blithely dismiss the costs of uncompensated care, which has been acknowledged by medical professionals and government officials. The authors simply chose to dismiss these costs, partly of out bias and partly because of their methodology, which we will discuss next.
Last, the authors rely totally on secondary sources, which largely used data from the Medical Expenditure Panel Survey, a survey of individuals, families, health-care providers, and employers. The data collected is useful but does have its limitations, most notably that it depends on individuals to provide precise and honest answers on a long and complex questionnaire. The methodology the authors employed in their analysis is little more than a survey of literature on the topic of immigration and health care costs, which the authors presented in a totally biased manner. The authors had access to the MEPS data which they could have analyzed themselves. By not doing so they repeated any mistakes or biases in the sources they cited.
Which brings us to the WBUR article. The headline, “Are Immigrants Health Care 'Moochers'? On The Contrary, Boston Researchers Say,” tells you all you need to know about how seriously the writer treats the topic (yes, those who write the article may not write the headline, but bad stories make for bad headlines).
The writer, Richard Knox, accepts the journal article’s claim without skepticism, while flippantly shunting aside other viewpoints. The WBUR article is part of the feedback loop, designed to amplify the “research findings.” And there are others.
Immigrants Not a Burden on U.S. Health Care: Study
Immigrants use little health care, subsidize care of non-immigrants: Harvard/Tufts study
Immigrants cost the health care system less than US-born Americans: Study
Presenting the journal article as a “study” suggests there was genuine research into the cost of immigration on the U.S. healthcare system instead of a review of selected literature presented in a way that confirmed a preordained conclusion. Here is a section of the WBUR article describing one of the journal article’s authors:
Dr. J. Wesley Boyd, a psychiatrist and ethicist at Harvard-affiliated Cambridge Health Alliance, says many Americans "just have this sort of general conception that foreigners who are coming across our borders trying to get a better life for themselves...[are] all just moochers.”
Boyd spends a lot of his time advocating for immigrants — in particular, testifying on behalf of those seeking asylum. So he was receptive when Tufts Medical School student Lila Flavin proposed a deep dive into the question: Just how much of a drain on the U.S. health care system are immigrants?
Boyd makes an outrageous and unfounded claim that goes unchallenged by WBUR’s Knox. Boyd’s credentials don’t change the fact that he is operating as an advocate, not as a scholar. Being an advocate doesn’t necessarily make his claims wrong, but it does give any ethical journalist the task to thoroughly scrutinize those claims. If Knox isn’t going to point out the flaws in the journal article, then at least he should point out its limitations. But the only limitation Knox points to is that it likely won’t convince skeptics the answer to the health care crisis is more immigration.
The WBUR article did include a couple of quotes from Dr. Steven Camarota of the Center for Immigration Studies, even if Knox characterized his measured remarks as a “concession.” Camarota pushed back against the notion that immigration results in a net gain to the U.S. health care system. He acknowledged that some illegal aliens do pay into Medicare through payroll deductions, while pointing out that in order to remain net contributors “they’ve got to stay illegal. Otherwise they’ll eventually add to the insolvency of Medicare.”
Camarota gets to the crux of the issue. The cost of providing health care services to immigrants is proportional to the access immigrants have to health care services. While there are fundamental disagreements about the role the government should have in providing or funding health care, Americans support all citizens, whether U.S.-born or foreign-born, having equal access to those services. Let’s just not pretend that immigration is a cost-savings device.
ERIC RUARK is the Director of Research for NumbersUSA
Updated: Thu, Aug 30th 2018 @ 10:35pm EDT