I saw this story on CNN.com. It's about how a German doctor who moved to Australia as part of a program to relieve a shortage of medical professionals down-under, especially in rural areas (my host-sister from the family I stayed with as an exchange student in Denmark is a nurse under the same program in a village clinic in NW Queensland). The controversy is that the German doctor had applied for permanent residency and been denied. He was denied because his son has Downs' syndrome. The people in the rural community he serves as one of the only doctors are holding rallies in support of his case. Now here's the thing. We can get bogged down in the unfairness of this (the doctor is certainly providing greater value in services to the community than his son would require) or we can look at this from a policy perspective. From a certain perspective, I can understand the Australian government's decision here.
Saturday, November 01, 2008
A Policy Interlude In a Deluge of Politics
The US may soon be taking one of the bigger steps towards universal health care that it's taken in a long time. Given that we share a long, relatively easily crossed border with a much less wealthy country, Mexico, we will soon be grappling with exactly this kind of problem (if indeed we aren't already). What obligation do countries with government provided health care have to provide health care to health care refugees? I don't know that I know the answer but here are some things to think about:
Could a government supplied health care system remain financially viable if it was burdened with an influx of health care consumers who did not pay into the system but demanded a lot of expensive care? This was not the case with the German doctor but I think this is the original motive for the regulations behind the Australian government's decision.
Do governments have a moral obligation to provide health care to all comers?
To what extent should anticipated health care needs play a role in immigration policy? That is do we envision a day when American Immigration officers will be asking people "Have you ever been a member of the Communist party? Have you ever belonged to a terrorist organization? Do you have an pre-existing health problems? Will you cary your own private insurance?" I don't know, maybe they already do ask those questions. Bell Curve and his wife can probably answer that for us.
Anyway, I think these are interesting questions and they are likely to become more important the greater the role public financing plays in providing health care in the USA.
Posted by Raised By Republicans at 4:48 AM
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In the United States, it woudl be illegal for an immigration decision to be based on disability, a protected status under the law. Teh fact that disability and cost are related is not relevant. I am surprised that Australia's civil rights laws do not extend to immigration.
As LTG says, discriminating against someone because they have Downs's syndrome--worse still, because they are caring for their son who has it!--would be a blatant violation of civil rights laws here. It astonishes me that Australia would do so.
RbR makes a nice segue into cross-border health care issues... But actually I think the flow across the border is reversed. Already there are a small number of American medical tourists who fly elsewhere to have operations they cannot afford here, and millions of Americans get their prescription drugs across the border in Canada and Mexico. I find it hard to believe US health care will ever be cheaper than that of our neighbors, so the primary draw will probably always be the other way around.
Regarding immigration, prospective immigrants are already required to take a battery of medical exams and present the results to the immigration officers. They could add more screening questions... But why? It is already so damned hard to get into this country legally that another level of screening hardly seems necessary. Those who we let in already are required to have sponsors, jobs, etc. I see no practical issue here. Exceptions can be dealt with on a case-by-case basis.
LTG, there are a large number of protections of civil rights in Australia, even though we have no Bill of Rights or equivalent, but as Pombat will attest the criteria for immigration into Australia are quite complex. (For example it is easier for a hairdresser to immigrate to Australia than for Pombat as a qualified mathematician as that is a trade.) I think the basic aim is to ensure that the burden on the taxpayer is not increased by allowing someone into the country. As Dr S points out countries impose a lot of criteria on potential immigrants.
I'd like to follow up on a different but slightly related topic but it may deserve a separate thread. I'll email Dr S and ask the good Dr for some advice...
So non-US citizens are provided equal protection under US civil rights laws as US citizens? That's reassuring to know - from various things I'd heard, I'd assumed that only US citizens were provided with the full protections of things like the Bill of Rights, and the rest of us just had to fend for ourselves.
This particular case has raised a few issues for me. First is that, regardless of whether you think the rule is fair or not, this doctor should have been made aware that they would not be eligible for permanent residency prior to moving his family halfway around the world. The fact that, as an intelligent man, faced with the battery of health tests you and your family have to go through to get a temporary visa, he should've guessed, and then questioned, whether his child's Down's syndrome would be an issue is rather irrelevant - the Dept of Immigration & Citizenship should have been upfront on that one. But then my personal experience with said department leads to a lack of surprise that they were not.
The thing that annoys me more though, is that the community he lives in are arguing for him to be able to stay, because he is useful to them. To be frank, I find it hard to believe anyone there would give a stuff about his plight if they didn't need a doctor. And I've seen a letter - written to The Age newspaper - from someone who definitely doesn't care: the guy in question is an Australian citizen, living in California with his US wife. Despite the fact that he is Australian, he cannot return home to live with his wife, because she is deaf and therefore does not meet the health criteria. His opinion seemed to be that if he, as an Aussie, can't come home with his wife, and isn't being helped, who cares about some European?
Incidentally, I don't think this doctor is being thrown out of the country: my understanding is that he could apply for a further temporary visa - in fact his current one is probably still valid, given that they tend to run for 3-4yrs, not just the two he's already been here - and that temporary visa would almost certainly be granted. He's just been told that he can't become a permanent resident / citizen (you have to be a permanent resident for a certain number of years before being eligible to apply for citizenship).
Now, onto the broader issues/info. Health checks for entry into Aus are extensive. You are not required to undergo any health checks for your standard tourist visa, nor do you need them for a working holiday visa, which are valid up to one year, allow you to work for a max of six months at each employer, and are limited to a certain age category, under-30s I think. However, questions on the application include whether you will be working with children or in medical establishments - I think answering yes to these would then lead to health checks.
For any other kind of visa, you need to get a health check, performed by a certified doctor, and paid for by your good self. Temporary working visas (such as the German doctor's one) involve having an all over body exam, including eyesight, hearing, poking & prodding of all organs (liver etc), blood pressure check, listen to the heart and breathing, breast exam, pap smear/testicular check in some cases, checking of all reflexes, mobility of joints, urine test, and chest x-ray to check for tuberculosis (apparently a stonking great scar on your arm from your teenaged vaccination does not suffice). The forms have a list of questions for the doctor to answer "normal / abnormal" - these run through all of the aforementioned, and also have "mental state" and "intelligence" as two further rows.
For a permanent visa, you go through all of the above - again - but add a blood test for hepatitis and HIV screening.
Of course, there are a whole load of other criteria unrelated to your health check - Spotted H is correct when he says that hairdressers fall into the "trade" category, along with such needed people as plumbers & fully qualified electricians, and so could find it easier to get an independent working visa than I could (despite scoring the highest possible on English speaking, age, etc etc, I did not get enough points to apply for one of those).
Now, as to whether it's fair or not to exclude people on the basis of any health condition: on the one hand, it doesn't seem fair to exclude anyone for something that isn't their fault. On the other hand, medical care in Australia is mostly taxpayer funded (it's complicated of course, and plenty of people have additional insurance etc, but the bulk of the money is from taxes). Therefore, is it fair to submit people who are already in the country to an immediate additional cost due to an immigrant's medical issues?
All countries have criteria that people have to meet to be able to move there - health, age, ability to support themselves, willingness to work, and many others. Where to draw the lines will always be hard - if Down's Syndrome is no longer a disallow criteria, then how about someone needing dialysis each day? - but they do need to be drawn.
I admit I know very little about Australian history (though I am hoping to learn more once the new Baz Luhrmann movie comes out ;o)). Having recently finished a very long book on child migrants to Australia, it seems like the pendulum has swung quite a bit.
The amount of care a person with Down syndrome needs is quite variable - there are some people with very mild health problems who are capable of living independently, but you also have absolutely heartbreaking stories of kids who need millons of dollars' worth of medical care. Frankly, I have no idea how you draw those lines.
Considering the immense trouble intelligent, qualified people seem to have moving between industrialized countries (my brothers-in-law, my college roommate), I have to wonder when this sort of thing starts to bite industrialized countries in the rear.
-Seventh Sister
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