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The consequential case of Jesica Santillan
Raleigh News & Observer ^ | 2/25/07 | Keith Wailoo

Posted on 03/21/2007 9:20:12 PM PDT by Huntress

Four years ago, a 17-year-old immigrant girl named Jesica Santillan died at the Duke University Medical Center, the result of a botched heart-and-lung transplant following a blood typing mix-up. Her story opened a window on potent myths and inflammatory perceptions surrounding illegal immigration, border crossing, scarce health care resources and the widely misunderstood way in which we allocate transplant organs in the United States.

It is worth revisiting the myths; more important, though, we should acknowledge the complex realities that ought to inform current debates about immigration and health care reform.

Myth No. 1 -- Jesica's case highlights how undocumented immigrants come here for free health care, and how they wind up taxing and burdening the rest of us.

Reality -- Studies show that immigrants come here for jobs. A recent study by the Texas comptroller argued that the taxes paid by undocumented immigrants more than cover the state services they use. And if we are going to debate border-crossing for health care, let's be clear on who's doing it: Americans, frustrated with our own medical system, who venture from northern border states into Canada for cheaper drugs, to Europe and India for surgery, and into Mexico for alternative medicines.

In the transplantation world, the phenomenon of pressing moral concern is that of wealthy Westerners traveling to developing countries to purchase kidneys or other organs in unregulated black and gray markets. These kinds of border-crossing highlight real crises that ought to command more public attention than the much-hyped immigrant health care threat.

Myth No. 2 -- Jesica's case, in which she received not just one but two sets of mismatched organs, shows how the transplant system can be manipulated, in this case by an undocumented immigrant family jumping the line ahead of others.

Reality -- The two factors that got Jesica into the transplant system were health insurance (through her mother's job), and the generous private patronage of a supporter named Mack Mahoney and caring citizens in Franklin County, where she lived. Most undocumented immigrants have neither.

Moreover, many critics have a naive understanding of the transplant wait list. It is not a first-come, first-serve grocery checkout line. Once Jesica was listed, a number of factors determined the "match," such as her size and the size of the organs available, the extent of her illness, the immunological specifics of the available organs and which of the 11 U.S. transplant regions she lived in. Contrary to what many believe, we do not have a national "sickest-first" policy, although one was proposed and heatedly rejected during the Clinton years.

Myth No. 3 -- After Jesica died, her family refused to donate her organs, even though she had received two sets of transplants, showing how foreigners and illegal immigrants take more than they give.

Reality -- Hispanics in the U.S. donate organs at rates equal to their population; we have little data on donation by non-citizens. In Jesica's case, her organs were probably not transplantable because her body had been suffused with immunosuppressive drugs to prevent her type O body from rejecting a type A heart. Although critics from Bill O'Reilly to Michele Malkin used the case to inflame anti-immigrant passions, such scapegoating belies how little we know about how non-citizens and undocumented immigrants give to the system.

To be sure, Jesica's misfortune carries many other lessons -- about malfeasance and error, about the nature of American generosity as well as its limits, and about malpractice (the case helped squash a Republican congressional drive to cap malpractice awards for pain and suffering). The case also points to the tremendous and growing gap in supply and demand for transplant organs.

U.S. demand for organs shot up fivefold from 16,026 in 1988 to 90,000 in 2006, according to a recent Institute of Medicine report. In 2003, Jesica was surely a victim of building frustrations around scarce supply and heavy demand in this unique winner-take-all arena.

Four years later, a tragic case that inflamed public discussion might now enlighten it. Rather than embracing the myths, we should remember what Jesica Santillan's life, cut short, tells us about the reality of immigration and the American health care system, and about how passions of the moment can blind us to the real problems we must reform.

(Keith Wailoo is Martin Luther King Jr. professor of history and health policy at Rutgers University. He is co-editor, with Julie Livingston and Peter Guarnaccia, of "A Death Retold: Jesica Santillan, The Bungled Transplant, and the Paradoxes of Medical Citizenship.")


TOPICS: Culture/Society; Foreign Affairs; News/Current Events
KEYWORDS: aliens; illegalaliens; illegals; immigrants; immigration; undocumented
Studies show that immigrants come here for jobs. A recent study by the Texas comptroller argued that the taxes paid by undocumented immigrants more than cover the state services they use.

What about private medical providers, Mr. Wailoo? Are they paid for the the services rendered to illegal aliens?

1 posted on 03/21/2007 9:20:14 PM PDT by Huntress
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To: Huntress

An 'undocumented immigrant' is an 'illegal alien that is breaking out law.


2 posted on 03/21/2007 9:26:23 PM PDT by Dustbunny (The BIBLE - Basic Instructions Before Leaving Earth)
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To: Huntress

I never take seriously any claims people make without backing them up. This guy uses the "studies show" line of BS, without saying which studies and from where.


3 posted on 03/21/2007 9:28:44 PM PDT by fr_freak
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To: Huntress
Studies show that immigrants come here for jobs. A recent study by the Texas comptroller argued that the taxes paid by undocumented immigrants more than cover the state services they use...sophistry - many might come for jobs, but those who do still soak up plenty of free medical care - and those who do pay taxes may pay enough to cover the cost of services they receive - but did the comptroller bother to look at how many never paid taxes......
4 posted on 03/21/2007 9:31:20 PM PDT by Intolerant in NJ
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To: Huntress

Is this guy on the same planet as the rest of us?


5 posted on 03/21/2007 9:31:53 PM PDT by freekitty
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To: Huntress

Is this guy on the same planet as the rest of us?


6 posted on 03/21/2007 9:32:17 PM PDT by freekitty
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To: fr_freak

Okay, illegals pay the taxes to cover their "healthcare." Now, unto the burden they create in DWL, DWI, and DUI acccidents with fatalities. For starters.


7 posted on 03/21/2007 9:33:55 PM PDT by BradyLS (DO NOT FEED THE BEARS!)
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To: BradyLS

"Okay, illegals pay the taxes to cover their "healthcare."

And if the illegal aliens hadn't stolen the jobs rightfully belonging to American citizens, American citizens would have paid those taxes to pay for their healthcare.


8 posted on 03/21/2007 9:38:43 PM PDT by baubau (BOYCOTT Bank of America for Issuing Credit Cards to 3rd World Illegal Aliens.)
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To: baubau

You're rigght. I shoulda put "pay" in quotations...


9 posted on 03/21/2007 9:41:02 PM PDT by BradyLS (DO NOT FEED THE BEARS!)
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To: Huntress
Federal statistics:

Estimated first-year cost of a heart transplant, $391,000.

I wonder what the first-year cost goes up to when a lung transplant is added.
10 posted on 03/21/2007 9:42:45 PM PDT by ruination
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To: Huntress

How many children does the typical illegal have in school?

Just one family with three kids is receiving nearly $30,000 in state services every year they are in school. How many working illegals without children does it take to pay that back in taxes?

I do not believe that they pay anywhere near what they cost us in just education expenses. Now add medical care, law enforcement, court time and prison time and is way over the top.


11 posted on 03/21/2007 9:45:48 PM PDT by DB
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To: DB
The first year cost for a heart-lung transplant is estimated to be $640,800. (pdf)

I wonder why Keith Wailoo didn't bring that issue up.
12 posted on 03/21/2007 9:58:10 PM PDT by ruination
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To: Intolerant in NJ

I googled Texas undocumented workers and health care and came up with a study by the Texas comptroller published last December. Carole Keeton Strayhorn issued the study which said undocumented workers added $1.58 billion in state revenue and used $1.16 billion in state services. In the same paragraph, in fact immediately following those figures, the article also states "However, local governments bore the burden of about $1.44 billion in uncompensated health care costs and local law enforcement costs not paid for by the state." So the good professor cherrypicked the study and disregarded the costs that the state does not directly pay through general funds.


13 posted on 03/21/2007 10:10:57 PM PDT by caseinpoint (Don't get thickly involved in thin things.)
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To: Huntress
Pay their own way? How about that illegal with the 3 or 4 kids in the public schools at $10-12000 a pop here in Portland. Ain't no way they pay their way overall. What about the extensive use of OHSU for the birth of their children?

Nam Vet

14 posted on 03/21/2007 10:59:50 PM PDT by Nam Vet ( The original point and click interface was a Smith & Wesson.)
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To: Huntress

That is BS. My husband makes way more money than an illegal, the taxes he pays could not cover the cost of childbirth and healthcare for our entire family. And why are hospitals closing at such a rapid rate? Cause the illegals don't pay.


15 posted on 03/22/2007 4:06:32 AM PDT by panthermom (DUNCAN HUNTER 2008)
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To: Huntress; All

Gee, wonder who's SS# is being used to pay those taxes? What form of ID is the mother using to get her health insurance and a job?


Where's the GD Barf Alert?


16 posted on 03/22/2007 4:46:26 AM PDT by wolfcreek (Semi-Conservatism Won't Cut It)
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To: Huntress

#3 may be the only one that makes sense but he is only guessing?


17 posted on 03/22/2007 11:00:58 AM PDT by art_rocks
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To: panthermom
My husband makes way more money than an illegal, the taxes he pays could not cover the cost of childbirth and healthcare for our entire family.

If the author is to be believed, the costs were borne by a combination of her mother's health insurance, and a private benefactor (whose name was given, btw).

18 posted on 03/22/2007 11:12:50 AM PDT by r9etb
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To: fr_freak
I never take seriously any claims people make without backing them up. This guy uses the "studies show" line of BS, without saying which studies and from where.

Here is the Texas Comptroller's report. (You could easily have found it yourself, you know.... the guy did reference it pretty specifically. I found it on the very first try.)

The report states that there are significant costs associated with illegal immigration. On balance, however, report concludes that:

The Comptroller’s office estimates the absence of the estimated 1.4 million undocumented immigrants in Texas in fiscal 2005 would have been a loss to our Gross State Product of $17.7 billion. Also, the Comptroller’s office estimates that state revenues collected from undocumented immigrants exceed what the state spent on services, with the difference being $424.7 million

So ... will you take his claim seriously now?

19 posted on 03/22/2007 11:19:38 AM PDT by r9etb
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To: r9etb

I wasn't talking about Jessica, I was talking about the Texas Comptrollers claim. Also, there is another post on this thread where someone actually looked up the report and pointed out that the reporter cherry picked this claim.


20 posted on 03/22/2007 12:01:29 PM PDT by panthermom (DUNCAN HUNTER 2008)
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To: panthermom

I looked at the conclusion of the report, which states that illegals generate $474 million more in taxes than they use.


21 posted on 03/22/2007 12:10:53 PM PDT by r9etb
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To: r9etb

Oops. $424.7 million more.


22 posted on 03/22/2007 12:11:16 PM PDT by r9etb
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To: panthermom; All

The Texas report is bogus. It ignores MUCH. Like the earned income credit the few that do pay taxes get back.


http://www.cis.org/articles/2004/fiscalfindings.html

Treasury Department Report. The results of our study are also buttressed by an analysis of illegal alien tax returns done by the Inspector General's Office of the Department of Treasury in 2004.35 That study found that 55 percent of illegal aliens who filed income tax returns using tax identification numbers had no federal income tax liability. While higher than the 45 percent estimated in this study, it must be remembered that this figure was only for those who filed tax returns using a tax identification number. These are all individuals who expected refunds, otherwise they would not have gone to the trouble of getting tax identification numbers and filing a return. But like our estimates, the Inspector General's report indicates that roughly half of illegals have no tax liability, reflecting their very low incomes and large number of dependents. ________________

http://www.ustreas.gov/tigta/congress/congress_03102004.htm

The number of ITINs issued in the last few years has increased dramatically, climbing from 1.1 million in 2001 to 1.5 million in 2002--a one-year increase of about 36 percent. Normally, ITINs would be used to file a Form 1040NR—U.S. Nonresident Alien Income Tax Return. However, many ITINs are used to file Forms 1040, which creates challenges for tax administration. Our analysis of Forms 1040 filed in Tax Year 2001 with ITINs found that approximately 530,000 Forms 1040 were filed with ITINs as the primary number by aliens who resided in the U.S., but who were not authorized to work and, in general, to reside in the U.S.

* These returns reported adjusted gross income of $10.7 billion. After tax deductions and credits, these tax returns reported a total liability of $184 million. * Over half of the tax returns reported no tax liability, and $522 million in tax refunds were claimed on these returns.



http://transcripts.cnn.com/TRANSCRIPTS/0701/04/gb.01.html

BECK: This is insanity. You know, I just saw a number -- and tell me if this number is right, if you even have it -- I just saw a number on, in 2004, what we paid illegal aliens in tax refunds, 2004. Do you know this number?

CAMAROTA: Yes, I believe -- the figure I`ve heard is about $10 billion. That`s based on estimates that the Treasury Department has done itself, $10 billion they paid back to illegal aliens.

BECK: That is insane. We`re paying them $10 billion, and we can`t arrest them, we can`t even find them, we don`t even know -- $10 billion? And now we`re giving them Social Security, one that we don`t need another country to sabotage for us. We`re doing it ourselves. The whole thing is going to collapse.

CAMAROTA: Yes, and what`s worse than that is, that the IRS issues them tax I.D. numbers so that they can then file their income tax with their false Social Security numbers so that we can give them their $10 billion back.

BECK: OK, all right. So the last thing here -- let me just role play here for a second. I`m an illegal alien. I have to now go to the government and prove to the government that I have a fake I.D., that I bought a fake Social Security card on the street in the black market, and then the government rewards me for that, right?

CAMAROTA: Yes, in effect, sure. Once you get legal status, then you apply for the credits that you earned while you were an illegal alien. And the way you do that is like you said: You show your false documents. You bring out your bogus tax returns, and so forth.


23 posted on 03/22/2007 12:23:34 PM PDT by AuntB (" It takes more than walking across the border to be an American." Duncan Hunter)
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To: Huntress; Dustbunny; baubau; fr_freak; All

Transplant patient, illegal alien, dies. Unfortunate.

She could have been one of these transplant patients who died because of a disease dragged over the border by one of her countrymen.


Rare Disease Reported in Transplants
Jul 27 2:16 PM US/Eastern
Email this story

By MIKE STOBBE
AP Medical Writer

ATLANTA

Two U.S. heart transplant patients who died earlier this year had
contracted a parasitic tropical disease from their new organs, health
officials reported Thursday.

The two California men are the fourth and fifth U.S. patients believed
to have been infected with Chagas' disease through organ transplants,
according to the Centers for Disease Control and Prevention.

Organ donors are screened for Chagas' in South America, where the
disease is much more common. No screening test for Chagas' is licensed
in the United States.

The two men, ages 64 and 73, died at separate Los Angeles hospitals
after being treated with Chagas'-fighting drugs from a special CDC
stockpile of medicines not available in this country.

The infected organs came from one person born in Central America and
another who had traveled to Mexico, the CDC reported.

One of the transplant patients died of something other than Chagas'
disease, CDC officials said. No autopsy was done on the second man, so
the role of Chagas' in his death is not known, said Heather Kun, a CDC
epidemiologist who led the investigation.

Chagas' disease can cause high fever, swelling, enlargement of the
spleen, liver and lymph nodes, and inflammation of the heart.

Most people infected do not get sick, but the disease can be fatal in
some cases and can be especially dangerous to people with suppressed
immune systems. Transplant patients receive immune-suppressing drugs
to prevent organ rejection.

"We think physicians need to look out for this" in patients taking
medication that suppresses the immune system, said Dr. Anne Moore, a
CDC epidemiologist.

In 2001, the CDC reported three cases of Chagas' in three U.S. women
who had received organs from an immigrant from Central America.
Doctors presumed the donor was infected, but no specimens were
available for testing.

Chagas' is spread by reduviid bugs, which live in the cracks and holes
of substandard housing. They are called "kissing bugs" because they
often bite people in the face. The bugs' feces contain a single-celled
parasite that can get pushed beneath the skin when people scratch
themselves or rub their eyes.

About 12 million people in Central and South America are infected with
Chagas', but only 100,000 U.S. residents have it, according to rough
estimates.

http://groups.google.co.jp/group/misc.health.alternative/browse_thread/thread/e324fe4436ac94a1/5db793b6948f75cd?lnk=raot


24 posted on 03/22/2007 1:05:58 PM PDT by AuntB (" It takes more than walking across the border to be an American." Duncan Hunter)
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To: r9etb

What about medicaid, food stamps and education?


25 posted on 03/22/2007 1:34:10 PM PDT by panthermom (DUNCAN HUNTER 2008)
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To: AuntB

Thank you for your diligence. I believe illegals have been taking us to the cleaners. I was in a situation where my son needed emergency dental work, our dentist did not have hours and I went to a children's clinic. It was packed, I sat for 3 hours watching Mexican T.V., I was one of the very, very few who actually spoke english, I sat right next to the desk and watched one by one, as everybody but me used a medicaid card while I had to pay for services.


26 posted on 03/22/2007 1:40:37 PM PDT by panthermom (DUNCAN HUNTER 2008)
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To: panthermom

I'm afraid it's going to get worse before it gets better. 2 years ago, my x husb was in a car wreck, broken leg, shattered ankle, bruised sternum, etc. They took him to LA county. About a week later, I found out about the wreck. In two weeks they had not even xrayed him! When he'd ask for a phone, they'd drug him. He was just about dead by the time my kids got down there. And NO ONE in the place could speak English. This is how we treat our combat veterans.


27 posted on 03/22/2007 1:52:32 PM PDT by AuntB (" It takes more than walking across the border to be an American." Duncan Hunter)
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To: r9etb
Here is the Texas Comptroller's report. (You could easily have found it yourself, you know.... the guy did reference it pretty specifically. I found it on the very first try.)

The Texas Comptroller's report is the ONLY thing this guy actually referenced, although he referred to numerous other "studies". And yeah, I could have looked it up easily, smart guy, but I didn't doubt that the comptroller's report said what he claimed - I only doubt that the comptroller's report is a definitive picture of what is really going on, either in the country, or even just in Texas. As an example of one probable flaw, I'm sure the comptroller does not include anchor babies in the cost statistics of illegal aliens, because they are technically citizens, even though they would never have been citizens if their parents hadn't broken US law in the first place.

The main point is that if you are going to write up an essay on how the belief that illegal immigrants are more of a cost than a benefit is pure myth, you need to cite a source for every hard number you claim.
28 posted on 03/22/2007 3:17:17 PM PDT by fr_freak
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To: caseinpoint
...the article also states "However, local governments bore the burden of about $1.44 billion in uncompensated health care costs and local law enforcement costs not paid for by the state."...Excellent find - stands to reason that local costs such as health care, schools, and law enforcement would be most impacted by low-skilled illegals, many without social security numbers getting paid cash under the table and never paying taxes - only commonsense, but this is something which seems alien to most professors - pun intended......
29 posted on 03/22/2007 8:34:32 PM PDT by Intolerant in NJ
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