Covering illegal immigrants

President Obama's speech to a joint session of congress last night was marred by a Republican congressman who seems to have flunked "Raising Your Hand Before Talking in Class" in kindergarten. It was unprecedented in the U.S. Congress, which generally maintains decorum better than a lot of other legislative bodies.

It was particularly unfortunate that his shouted insult was directed to the first African American president of the United States. Many people will conclude, rightly or wrongly, that he would not have behaved that way to a president of his own race. It will just create a distraction by inflaming tensions that are completely off-topic to the health care debate.

But lets look at the substance here. What will health care reform mean in terms of the care given to illegal immigrants?

Probably nothing. I mean, let's get real. Look at what happens now.

Illegal immigrants are not eligible for government health coverage, no matter how ill or how poor. The only assistance the government is offering is a trip back to their own countries to get care there.

So any care they get they must pay for themselves. Few are able to get jobs that pay health benefits. They usually work for the employers whose wages and benefits are too low to attract legal residents.

Those jobs tend to be dirty and dangerous, and they tend to involve long hours. People are going to get sick. But they don't have the time or money to go to a doctor.

So they wait. And they get sicker. And eventually, they go to an emergency room.

Now, emergency rooms by law cannot refuse to treat emergencies. It's a federal crime to turn away women in labor or people with true emergencies because they can't pay. And some bureaucrat in an office thousands of miles away gets to play Monday morning quarterback after the fact to decide what was an emergency. So ER doctors are going to err on the side of caution in treating problems that might conceivably in some rare circumstances actually be symptoms of a true emergency. And they'll tend to avoid even asking about insurance or legal status rather than give someone any reason to suspect their decisions are based on financial considerations. So even those doctors who are so jaded by people who abuse emergency rooms that they have forgotten the compassionate impulses that attracted them to the field of medicine are currently treating illegal immigrants.

They just aren't geting paid.

And that care is costly, both because an ounce of prevention costs less than a pound of cure, but also because the lack of a "medical home" -- a primary care doctor who will coordinate care -- means that a lot of tests will be duplicated each time they show up at a hospital.

What will change in the new system? Like I said, probably nothing. No one ever lost an election because he lacked compassion for undocumented immigrants. And since the government doesn't need to worry about trying to get this population cared for more cheaply when it can already get doctors to provide this care for free, why would politicians or either side of the aisle bother to try to change things?

Everybody needs to chill. There are more important details to argue over than the one everyone already agrees on.