Planes, Trains and Automobiles to a Free Delivery

About seven years ago, we sat in on a parents’ meeting at the Lycee Francais Albert Camus in Conakry, Guinea, a country in West Africa. It was more out of curiosity than need, to observe how the French run these things, and the French parents were very nice and inclusive, so who could say no? There was just one item on the agenda that day, the discussion of a scholarship for a student, a Guinean girl. The scholarship had been stalled at the French Embassy for approval; the Embassy questioned whether the family qualified.

The father was there to plead his case. He had a right to French tuition assistance for his daughter because he held a dual French-Guinea citizenship. The head of the Parents Association, a French woman, noted that he’d received a loan from the United Nations Development Program (UNDP) to start a theatre business in a city a few hours from the capital. The man said he hadn’t been able to pay back the loan as the business had failed – too many videos and DVDs available. We listened as they went on to note his current income and so forth. The father argued very persuasively that he qualified.

They then noted that they found it hard to believe he didn’t have means because he’d written down his youngest son had born recently in the USA and was listed on the application forms as a US citizen. It was quite common to meet families in those places with kids born in various countries, a different passport for each kid, so that wasn’t surprising. But the French ladies persisted with their coup de grace, if he didn’t have the means, how did he afford paying airfare and US medical bills for his wife’s delivery in the USA, in an expensive US hospital?

The man sat up and exclaimed, “It didn’t cost us ANYTHING in America for the delivery. It’s FREE!” He spread his hands and absolutely beamed with genuine, delighted awe, “It was wonderful! Beautiful hospital, nurses, doctors, clean, and it was all free! American hospitals are superb and they are all so nice to you!”

To say the flabbergasted looks on the two French women were priceless is an understatement. Rendered speechless, their deer in the headlights eyes met ours … the American in the room … and it took nearly superhuman effort to not burst out laughing at them, lean across the table, high-five and shake the man’s hand, so awesome was this demolishing of the totality of the French conceit of their stereotyped opinions of American health care. It was a good thing though we restrained ourselves, because we would have clasped his hand with delight the one second, and then punched him the next moment.

We have six children, and they were all born in the USA. They weren’t “free.” We pay insurance and co-pay and the hospitals billed us, and quite creatively. We learned early on that 50-cent hospital pacifier was about $10, the “complimentary bag” of mostly manufacturers’ samples was about $100 and so forth. But the bottom line was, the hospital billed us and by extension our insurance company, not just for our children’s births, but for this Guinean man’s son’s birth, too. He scraped the money for an almost two-thousand dollar round-trip air ticket; his wife waddled into a US hospital emergency room and gave birth on our dime. At least we hope she waddled in on her own steam, and didn’t call 911 so the EMTs bought her in … at additional unreimbursed taxpayer expense.

Their son also got a crisp state of the art blue US passport as a US citizen. Mom and baby US citizen flew back to Guinea where he has been raised as a Guinean Susu-Francophone bi-lingual African who doesn’t speak English. But if any emergency which requires the United States Embassy to have to evacuate all US citizens out of Guinea, this boy is on the evacuation list, and would of course, while he’s young, require a family member accompany him. All paid for by the US taxpayer. There are more than hundreds of thousands of US citizens growing up in other countries who were born in the USA, but have no language or cultural ties or affinity for it, they are their families’ emergency exit tickets. International flights have women sitting awkwardly in tight airline seats, late in their third trimesters, claiming they aren’t, headed for the USA every day to give birth.

Frankly, who can blame them? Guinea’s per capita GNP is abysmal – under $500 per year – parking it squarely in the World Bank’s Low Income nations grouping, the world’s poorest nations. Compare that to Mexico’s Middle Income status at about $6,000 per year, and Mexico is what many Americans think of when they think “underdeveloped.” Guinea’s infant mortality runs in the 140 per 1000 live births range while America’s infant mortality runs closer to 5 per 1000 live births – which include the incredibly delicate premature babies. So, if we were Guinean, we’d beg, borrow and steal the air ticket money together and fly to the USA, for the world’s best health care for free, too.

It’s legal, but it isn’t free to provide. Hospitals buy supplies, buy medicines, pay nurses, technicians, janitors, pay electricity, water, heating, cooling, invest in state of the art scanners, x-rays, labs … the costs are numerous. Our bills went up with each child. But the hospitals were scrambling to cover mounting expenses they’d incurred by treating zero-pay walk-ins. No one wants to turn away anyone in need, but when more money goes out than in, hospitals go bankrupt and close, and everyone suffers, so ignoring this is not viable.

This is exactly the sort of problem that Americans expect to be fixed with any “health-care reform,” but there is nothing that addresses this untenable situation, in fact it stands to get worse, a strained and ultimately abusive give-away for foreigners, at the expense of nationals.

Congress is quite capable of crafting a logical and sensible guest-worker program for foreigners who want to work in the USA, which includes a simple requirement for any guest worker to buy and provide proof of a basic healthcare insurance coverage while in the USA. This would provide a huge relief for hospitals with large Mexican and Central American walk-in patient demands, and private insurers would have plenty of new clients to compete for instead of paying out for. Under this, any children born of foreigners in the USA would not be automatically citizens, but have a certificate of birth that requires them to have a set number of years of residency requirement by age 18 before being eligible for permanent US citizenship. Likewise, foreign nationals who make the effort to fly to the USA should be required to have insurance coverage that will pay for any medical costs incurred in the USA during their proposed sojourn. If a Third World woman is on an airplane, chances are she’s got some reasonable means to pay a short-term insurance policy, at a minimum. The poorest people of these nations never get on the plane in the first place, so this current arrangement enables a subsidy to the Middle and Upper Class of the home nations who have simply availed themselves of a golden opportunity on the backs of Americans who buy their own private coverage and take care of their own bills responsibly.


  1. I gather from your post that one of two things happened:

    1. No bill was proffered by the hospital

    2. He ran out on the bill

    Which is it?

    And by the way, did she get the scholarship?

  2. Dear curious,

    No bill is proffered. To whom would they send it and where? The hospital is not allowed to ask if you are an illegal alien. It is also against the law to turn away any ’emergency’ patient. Of course if you are a citizen, you will need to show identification..but we can’t do that to an illegal!

    The basic reason for health care to have risen, ahead and beyond of inflation, is exactly because of ‘free’ health care to illegals, and like all super deals like this, every potential customer in the third world is well aware of the giveaway. There have been many a recipient of a new heart, or kidney or(?) that have gone, not to a deserving and paying citizen, but to an illegal who came here specifically for the gift. Then there are the hundreds of patients who are on perennial life support that Mexico et al will not take back. Our expense can run into a million in just one year for just one patient.

    AND Joy of joys, health care REFORM will NOT fix this egregious problem.

    But this is just another part of that nasty SINGLE problem of illegal aliens!

    I understand that Rep. Luis Gutierrez will soon offer up another amnesty.

  3. Curious Says:
    December 15th, 2009 at 8:01 am
    I gather from your post that one of two things happened:

    1. No bill was proffered by the hospital
    2. He ran out on the bill
    Which is it?

    And by the way, did she get the scholarship?
    The wife went into emergency. She left the hospital and flew back to Africa. They did NOT PAY ANYTHING. And frankly, he could have paid, given his economic status. He certainly could have afforded a medical insurance, but he didn’t need to bother, because of how the system is set up now; his wife got ALL what she needed without putting any extra money out. The hospital was left with the tab.
    And actually, I don’t know if the girl got the scholarship, they took his comments “under consideration.” I would guess that being French, and in Guinea, they decided they didn’t need the political trouble and finally approved it. If the guy could get a loan from UNDP, then he had connections, and it would be very prudent not to forget that in a place like that.

  4. One of the mysterious of life is that the Democrats have been dominant in Congress for decades and decades and have never offered up a common sense and practical guest worker system that would benefit especially Mexicans to come in legally to work, and pay for medical insurance, rent accomodations without hassles, etc., but Democrats haven’t done anything except sit on the current unworkable system while intoning how mean everyone else is for not tolerating illegals.
    What a crock.

  5. Wanumba,

    I agree this is a major problem and needs to be fixed but how would a guest worker program stop what you are describing? If you have a guest worker program where people are encouraged to come and they have to pay for insurance and all these things thats all well and good but that does not cover the rich person in another country from coming to the US when she is 8 months pregnant and going to an emergency room.

    No guest worker program fixes that…

  6. Johnny, that was in the last paragraph.
    But here’s more info to clarify how easy it is to make sure foreign VISITORS have insurance before arriving in the USA.
    To get on an airplane to the USA right NOW, foreigners before departure are obligated AT THE AIRLINE TICKET COUNTER to show a valid US Visa in their passport or they are not allowed to board. The airlines are motivated – if a passenger disembarks in the USA (or any other destination) without a valid visa, they are sent back next flight. The airlines are not interested in eating that cost.

    The US tourist visa application approval can easily include a proof of insurance – thru recognized/established private insurance companies. No insurance, no visa. No airline boarding. Simple.
    There are a lot of Americans and Europeans who purchase SOS (it’s a company) emergency evacuation insurance before traveling or working in certain countries. It covers medical emergencies that require rapid evac from the country to better medical facilities. The cost of SOS used to be about $200 and would cover 100% an air evac from Africa to Europe – by medical team staffed Lear jet – a service that was upwards of $20,000, just to give an idea that the SOS insurance was well worth the price. People without the SOS insurance would have to post a $20,000 bond at the bank before the jet would be dispatched.

    The example is to show that an international precedent for insurance requirements as part of visas and work permits already exists. Anyone flying into the USA MUST have a visa issued by the US Embassy Consular Office in their home country.

    If we had a rational guest worker program, guest workers could have a proper guest worker ID with guest worker insurance, hold their heads up high as legal guest workers, the hospitals could get paid, no more furtive behavior, and the nasty, thuggish, bribe-demanding border coyotes would be out of work.

  7. “Under this, any children born of foreigners in the USA would not be automatically citizens, but have a certificate of birth that requires them to have a set number of years of residency requirement by age 18 before being eligible for permanent US citizenship.”

    Yeah, how simple would it be to overturn the 14th amendment.

  8. Todd,
    We require five years residency for naturalized citizenship now. Foreign parents on temporary visas or on guest worker permits are not citizens.

    The point wasn’t to offer an actual legal statute, but concrete ideas which could be used to develop a rational legal structure to address this problem.
    But instead of offering further useful ideas, brainstorming for problem-solving, as usual, it’s vapid negativity without constructive input.
    Stuck on stupid.

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