• Q&A: US healthcare reform
• On The World: Living with American health care

Read the Transcript
This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

MARCO WERMAN:  The last piece of the health care reform law is now on its way to President Obama.  He’s expected to sign it next week.  The law’s main purpose is to extend health care coverage to millions of uninsured Americans.  Non-Americans who are here illegally are still out of luck.  Here’s The World’s Alex Gallafent on what that could mean for the nation’s health care system.

ALEX GALLAFENT:  Health care plus immigration equals political combustion.  Indeed, undocumented immigrants are not covered by the health care reform bill.  But even without Joe Wilson-style interjections, the fact remains that the problems of health care and immigration are related.  So says Ira Mehlman.

IRA MEHLMAN:  The growth of immigration in the United States over the past several decades has had a direct impact on the growth of the medically uninsured in the United States.

GALLAFENT: Mehlman is with the Federation for American Immigration Reform, a group devoted to capping immigration levels and stopping illegal immigration.  He says it’s correct that he health care reform bill doesn’t extend coverage to illegal immigrants.

MEHLMAN: Number one, it is costly to the tax payers.  Number two it bestows recognition and benefits on people who should not be in the country in the first place.

GALLAFENT: But in a place like New York City, thousands of undocumented immigrants are a present and immediate concern.  Alan Aviles should know, he’s President of the city’s Health and Hospitals Corporation.  He runs a network of 11 hospitals in the city, including six level one trauma centers.

ALAN AVILES:  So in New York City we have an estimated 500,000 undocumented immigrants.  The New York City public hospital system, which is the largest in the nation, has been the principal safety net for new immigrant communities across New York for decades.

GALLAFENT: That hospital system treated about 450,000 uninsured patients last year.  Aviles says a very large percentage of that number were undocumented, or illegal immigrants.  They didn’t have insurance, but they needed care, and so they went, more often than not, to places like this.  Emergency rooms.  The problem for Aviles, he says, is that the health care reform bill funds expanded coverage for Americans partly by limiting federal funding for public hospitals like his.

AVILES: And this is being done under the assumption that the uninsured that we currently serve will largely become insured and that will replace those dollars that are now being taken off the table.  But the reality in urban centers like New York, particularly gateway cities like New York, who have so many undocumented immigrants among the city’s residents, that will not necessarily play out as predicted.

GALLAFENT: So Aviles is concerned about a funding gap.  Less money from the federal government and not much more money from newly insured patients.  Aviles is especially galled by the fact that undocumented immigrants, many of whom do work and pay taxes, won’t be able to buy insurance from the new government run exchange, even at full cost.  When they’re sick, someone, somewhere is still going to have to pay for their care.  Aviles says there is a glimmer of hope.  The federal government might end up taking less money away from states with large numbers of illegal immigrants, keeping those emergency rooms going.  But that wouldn’t amount to a real fix, says Ira Mehlman at the Federation for American Immigration Reform.  Cities like New York, he says, should be doing more to limit illegal immigration in the first place.

MEHLMAN: We shouldn’t be dealing with this at the emergency room door.  We should be dealing with this far earlier in the process by seeing to it that fewer and fewer people come and remain in the United States illegally, and therefore draw less on our vital social services.

GALLAFENT: That means immigration reform.  And for Sonal Ambegaokar it could be an opportunity to deal with unfinished health care business.  She’s health policy attorney with the National Immigration Law Center.

SONAL AMBEGAOKAR:  So right now, newly arrived legal immigrants, immigrants who have their green card, have to wait 5 years before they can be eligible to enroll in what we call the Medicaid program, which serves the lowest income folks.

GALLAFENT: Maybe that’s fair, maybe that’s unfair.  At the very least Ambegaokar hopes it will be considered as lawmakers turn to immigration.  New York hospital administrator Alan Aviles also sees immigration reform as a necessary step in expanding health care.  If undocumented immigrants are allowed to earn citizenship, he says, health benefits will follow.  Now that doesn’t square with Ira Mehlman, although he is hoping for a sober discussion on what all agree is an emotive topic.

MEHLMAN: Respecting people and understanding why they come here doesn’t mean that we should not enforce laws, that doesn’t mean that we shouldn’t set restrictions.  We need to be able to deal with immigration policy just like we deal with any other public policy in the United States.

GALLAFENT: Given the tone of the recent health care debate, that should be fun.  For The World, I’m Alex Gallafent in New York.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• BBC coverage
• Reporting US health care reform abroad
• Health coverage on The World

Read the Transcript
This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

MARCO WERMAN:  Democracy here in the U.S. can be a messy business.  The health care reform debate is but the latest example.  Today President Obama held a televised ceremony to sign the health care overhaul bill into law.  Mr. Obama told lawmakers and others at the White House that the bill marked the start of a new season for the country.

PRESIDENT BARACK OBAMA:  Here in this country we shape our own destiny.  That is what we do.  That is who we are.  That is what makes us the United States of America.  And we have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.  And it is an extraordinary achievement that has happened because of all of you and all the advocates all across the country.  So thank you.  Thank you.  God bless you and may God bless the United States of America.

WERMAN: The rest of the world has been watching closely and we’ve been bringing you a variety of international perspectives on the U.S. health care debate.  Today we get that from Justin Webb.  He was based in the U.S. for the BBC for eight years before moving back to Britain last year.  Webb now anchors the BBC’s main morning news radio broadcast, the Today Programme.

JUSTIN WEBB:  The big picture viewed from here in Europe is that America has taken a really important step, not towards a British style NHS, but a step in the direction of every American has a right having some kind of health coverage.  And that to really the rest of the rich world to be honest, but certainly to Europe, just looks to most people including senior conservatives here in the U.K., and I was talking to one the other day, it just looks like America joining the normal world as it were.

WERMAN: And for you Justin, issues of health care came right into the spotlight of your life just before Christmas in 2008.  You were living in Washington at the time and your son Sam got ill.  What happened?

WEBB: He was diagnosed with Type I diabetes, which is a horrible life-threatening illness.  It’s not brought on by any kind of lifestyle thing, it’s an auto-immune disease actually that just comes in youngsters and lots of people will know people with it if not have experience of it themselves.  And it was fascinating for us once we sort of got over the shock and the sadness about it all, to see how the American health care system coped and then really not much more than six months later to move back to Britain and see how the British system coped.  And as you’d expect there are strengths in each.  I think in a way, people in each country don’t fully understand the strengths of the other country.  That’s what I brought away from this.  So in the United States we were very well treated.  Sam was wonderfully well treated.  He had access to fantastic medicine and fantastic technology as an insulin pump that was made available very quickly under the American system.  Now there are all sorts of co-pays and things, it’s not as if it was free and our insurance certainly paid a lot of money, but we were well insured, so everything went rather well. So that was the situation in America.  We came back to Britain and lo and behold everything’s free.  You know, the test strips, a lot of people with Type II diabetes will know what I’m talking about now.  There’s test strips that you test your blood with.  You go to a British doctor and you say I’d like some more please and they say yes, how many?  And they just give them to you.  To be honest, it was an extraordinary sort of change.  I was really used to the American system where everything is accounted for and paid for by someone and quite often by you.  So here in Britain all these thing are handed out, but, although the medicine is just as good, and there’s no question in my mind that Sam is as well treated as he is here in America, I have to say that the technology, in particular that pump that pumps insulin into him is a very state of the art thing.  It is not, at the moment, available in the U.K., the particular pump that Sam uses.  And that is, at least in part because, the pump makers can make money in America and they can’t make it under the British NHS.

WERMAN: I’m wondering when you went back to the U.K., how much health care actually kind of showed up in your calculations about getting back to the U.K .and finding something that was perhaps better?

WEBB: Well that’s an interesting thing.  We would not have moved back here for the health care.  There’s no question at all that we were perfectly happy in America and we were well insured and had no prospect of losing it.  But I have to say that my son would be in the category of those people who would go along to a health insurer in years to come, and he wants to be a film director in Hollywood at the moment, he’s 10 years old so he can still have those dreams, what would he do for health insurance had the Obama bill not passed?  Now of course, American health insurance companies would have turned him down because he has a serious pre-existing condition.  If that genuinely does change, which it seems that it is going to now, then that for someone like my son, is a major plus.  It means that for him there is a possibility of working on either side of the Atlantic.  Of course it just means for American as well, and for everyone who has a pre-existing condition, it’s a greater freedom for that group of people.

WERMAN: The BBC’s Justin Webb, thanks very much for sharing your views and experiences with us.  I greatly appreciate it.

WEBB: Pleasure.  Nice to talk to you.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• Gregor Peter Schmitz: “US Health Care – Good for America, Bad for the World?”
• BBC coverage
• Video of President Obama’s reaction
• Health coverage on The World

Read the Transcript
This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

DAVID BARON:  Passage of President Obama’s health care overhaul made headlines around the globe.  The foreign reports who covered the debate and last night’s vote, include the Washington Bureau Chief for the Toronto Star, Mitch Potter, and Gregor Schmitz, he’s the U.S. Correspondent for German’s news magazine, Der Spiegel.  Both are in Washington.  Mitch Potter, to you first, how are Canadians reading the story of health care reform in America today?

MITCH POTTER:  Well it’s a bit of a paradox.  Canadians have been fascinated by this all along.  On one hand I think Canadians in large part are sort of cheering on Americans.  It in a sense validates the system we have.  We know that what President Obama has brought forward here is not a Canadian style system, but it’s moving in that direction and I think Canadians feel validated by the fact that the United States is moving in our direction, if you will.

BARON:  Right, well it would be interesting to point out that among some groups, Canada has been a bit of a punching bag.  People have said this is what we don’t want to become.  We don’t want Canada’s health care system.

POTTER: It’s true and it’s really been a political piñata.  Time and again the Canadian system has been cherry picked with isolate horror stories being conflated into something to scare away Americans.  And that, truly, has annoyed Canadians.  A lot of Canadians have taken offense as they have watched this play out.

BARON: Now Gregor Schmitz, you had an opinion piece in Der Spiegel today and the headline reads “U.S. Health Care Good for America, Bad for the World”.  Now what do you mean by that?

GREGOR SCHMITZ:  Well I think if you look at the more recent debates you see there is a real risk that Obama might become a one issue President.  And I think if you look more closely at his speeches over the past weeks or months, there was basically no reference to other conflicts, or say other challenges, let’s say Afghanistan, even though soldiers are fighting there increasingly there now in recent weeks or months.

BARON: Because he’s been so wrapped up in health care.

SCHMITZ: Exactly he has been so wrapped up in health care and I don’t think anyone has predicted for this to drag out for so long.  So I think there is a real risk.  If you look at other parts of the world, particularly Europe, they are becoming a little disillusioned by a lack of interest.  He had to cancel the trip to Asia which I think was understandable in the context of the health care debate.  But still, it sent a signal to the rest of the world that this is the most important issue to us, understandably, and we don’t really care about the other challenges.  So I think there is a real risk for him to become a one issue President.

BARON: Well something I would like both of you to address is the way that Barack Obama is perceived around the world.  We know that when he was elected President in 2008 he was extremely popular in other countries.  How popular is Barack Obama in your countries now and I wonder to what extent have people in your countries been cheering on health care reform in the U.S. because they wanted to see President Obama succeed.  Mitch Potter, let’s start with you from Canada.

POTTER: Well I think that’s largely the case with Canadians.  There’s a recognition that we may not have a force in this health care fight, but if anybody is looking to see an Obama administration assert itself on other foreign files, they recognize that he needs a victory.  You can debate the wisdom of whether to have invested do much political capital to make health care his signature project was the right thing to do, but imagine how politically ham strung he would be in trying to pursue the rest of his agenda if this had all fallen apart on him and he would be approaching these mid-term elections with absolutely nothing to show for this first period of his Presidency.

BARON: But bottom line he is still popular in Canada?

POTTER: Definitely.

BARON: And in Germany Gregor Schmitz?  What is President Obama’s approval rating over there these days?

SCHMITZ: It probably has slipped from 99% to 97%.  I think overall he is still very popular in Europe and I think it is true in this regard when you look at health care that it is not about Obama.  It is about America.  Mitch has already alluded to that.  Europeans are cheering on the Americans because for them it’s just beyond imagination that the richest country on earth hasn’t been able, for so long, to provide basic health care coverage to every citizen.  So for Europeans that is more of a moral issue.  Frankly, they just don’t get it.  And I think on this specific issue, Obama is getting a pass.  I think they look at Washington and they basically blame the Republicans for blocking everything.  But one thing that I think is missing in the European debate that makes it harder for us to explain the debates here in the U.S. is the fact that many Americans are actually happy with the health care system.  When Europeans look at the American health care system, they don’t fully understand that the people who are a part of the system now, who have coverage, who have insurance are often very happy with the way they are being treated and with their options.  So I think that is something we need to explain to our readers that these debates are so fierce because it is the question of whether they want to extend that coverage or an offer of more solidarity to other Americans and whether they want to include the people that are left out right now.

BARON: Well gentlemen I expect you didn’t get all that much sleep last night.  Thank you for coming in.  It was good to talk to you.  Mitch Potter is the Washington Bureau Chief for the Toronto Star, thank you Mitch.

POTTER: Thank you very much.

BARON: And Gregor Schmitz is U. S. Correspondent for Der Spiegel in Germany, thank you.

SCHMITZ: Thanks for having me.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• BBC coverage
• The BBC’s Jonathan Beale analyzes the President’s speech
• Full text of the speech

Read the Transcript
This text below is a phonetic transcript of a radio story broadcast by PRI’s THE WORLD. It has been created on deadline by a contractor for PRI. The transcript is included here to facilitate internet searches for audio content. Please report any transcribing errors to theworld@pri.org. This transcript may not be in its final form, and it may be updated. Please be aware that the authoritative record of material distributed by PRI’s THE WORLD is the program audio.

MARCO WERMAN: I’m Marco Werman. This is The World. President Obama today picked up where he left off last night in his push for healthcare reform.

BARACK OBAMA: I am confident the plan that we’ve put forward is the right plan for the American people. I continue to be open to suggestions and ideas from all quarters – house members, senate members, Democrats, Republicans, and outside groups. What we cannot do is stand pat. What we can’t do is accept a status quo that is bankrupting families, businesses, and our nation.

WERMAN: The president also said he accepted an apology from South Carolina Republican Joe Wilson. Last night the congressman heckled Mr. Obama. He yelled, “You lie” just as the president said that healthcare reforms would not apply to illegal immigrants. We’ll have more about that breach of protocol in a few minutes. First The World’s Matthew Bell has been doing some fact checking. He explores how Democratic healthcare plans would deal with immigrants – both legal and illegal.

MATTHEW BELL: Healthcare reform and illegal immigration – two contentious issues that when combined apparently got the best of Congressman Wilson. But he’s far from the first person in weeks to become animated over the suggestion that illegal immigrants might receive new benefits through healthcare reform. Questions about this notion came up during town hall meetings over the summer and at protests like this one during a presidential visit to New Hampshire last month.

PROTESTOR: They should be sent on the first bus one way back to where they came from. We don’t need illegals. Send them home with a bullet in their head the second time.

BELL: Last night president Obama attempted to put the issue to rest. He said the claim that reform efforts would provide insurance to illegal immigrants is false and that reforms he’s proposing would not apply to people here in the US illegally. But Steven Camerota isn’t buying it. He’s with the Center for Immigration Studies in Washington. The group advocates for stronger limits on all immigration into the US.

STEVEN CAMEROTA: What we have right now is analogous to a speed limit sign on a highway that the police have said they’re never going to patrol. So the sign is there – the law is there – but the enforcement provision is not.

BELL: Camerota says yes there is language in healthcare reform legislation being debated now that says illegal immigrants are not eligible for government subsidies but he says the legislation doesn’t include reasonable enforcement measures.

CAMEROTA: There’s a program called the save system which runs people’s names through databases to make sure that they’re entitled to the programs that they’re trying to sign up for. That provision [INDISCERNIBLE] left out of this bill and then when it was voted on in committee it was killed.

BELL: But advocates of the current reform efforts say it’s a work in progress and it’s not clear yet what kind of verification measures will be used to make sure that undocumented immigrants don’t receive benefits they’re not entitled too. The enforcement mechanisms used by government programs like Medicaid will stay in place and whatever new programs are created they will include a system for determining eligibility as well.

LEIGHTON KU: This is clearly is an example of where people are trying to raise a boogieman that does not exist.

BELL: Leighton Ku is a professor of health policy at George Washington University.

KU: It is true that the health reform bills that are being considered by congress and what the president is considering would not provide any federal subsidies for the undocumented. However one of the points that’s come up as a sticking point periodically in the senate was whether legal immigrants would be eligible to participate in the health insurance exchanges and to get some of the federal subsidies that were being considered as a way of making health insurance more affordable for low and moderate income people.

BELL: Ku says giving legal immigrants access to health insurance pools is probably good policy and good economics. As a group, immigrants tend to be younger and healthier and they use health services than native-born Americans. That means making health insurance to legal immigrants could actually lower health premiums for everyone. For The World I’m Matthew Bell.

Copyright ©2009 PRI’s THE WORLD. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to PRI’s THE WORLD. This transcript may not be reproduced, in whole or in part, without prior written permission. For further information, please email The World’s Permissions Coordinator at theworld@pri.org.

• BBC coverage of the health care debate
• The Guardian newspaper: Is public healthcare in the UK as sick as rightwing America claims?
• Zack Cooper’s LSE profile