Obama has said, proudly and often, “I am going to give health insurance to 47 million Americans who are now without coverage.” Are 47 million “Americans” without coverage? The 47 million statistic includes illegal immigrants, who virtually all lack insurance. In fact, about one in four of those lacking insurance is here illegally.

About 15 million of the remaining uninsured are eligible for Medicaid but haven’t signed up. There may be a number of reasons for this, e.g. fear of the doctor, uninformed of eligibility, not sick enough to go to the doctor. If and when they choose, they can enroll in Medicaid and taxpaying Americans will pick up the full tab for their health care.

What about the rest of the uninsured pool? Almost all the children in this group are eligible for the State Children’s Health Insurance Program. Some aren’t enrolled because the parents haven’t bothered, but most are eligible. That leaves about 20 million uninsured adults who are US citizens or legal immigrants. Of these 7.3 million come from families with incomes of $75,000 or more, and an additional 6.9 million earn between $50,000 and $75,000, according to 2006 census estimates. A recent analysis by the New America Foundation, a Washington policy group, found that 16 percent of the patients who received uncompensated medical care in 2004 had family incomes of at least four times the federal poverty level (which means they currently earn about $41,600 for an individual and $84,800 for a family of four).

Judging from the numbers alone, it would seem that there are far better ways to handle the medical needs of the uninsured than to turn our entire health-care system upside down.

Free Health care for illegal immigrants might be the biggest unmet medical need in our nation, and Obama’s program targets it squarely. But do we really want to give them federally paid coverage equal to what US senators get, as Obama proposes? Illegal immigrants now get free emergency-room treatment for life-threatening and other conditions, as any other American who’s entered an ER in an area with lots of illegal’s recently well knows. (Three-quarters of the illegal-immigrant population is concentrated in five states: California, New York, Florida, Texas and Illinois.)

Covering illegal immigrants adds dramatically to the cost of any health care program. Under Obama’s plan they’d be eligible for the entire range of medical services, all free of charge. Undoubtedly, this would encourage more folks to enter the United States of America illegally.

Furthermore, Obama’s plan will likely have a horrific effect on some local health-care systems. An influx of millions of the currently uninsured would likely cause severe rationing of needed medical services. And puts bureaucrats in charge of deciding who gets to see an oncologist, who can have an MRI – and even who can have bypass surgery and who’d die for lack of it.

These decisions would be made not on the basis of legal status but on the brutal facts of triage: Treat the 19-year-old illegal with his whole life to live before you spend scarce resources on an overweight, diabetic, 50-year-old citizen with high blood pressure, who works hard and paid taxes his whole life.

John McCain hasn’t raised this issue, perhaps for fear of offending the Latino vote. This is a tactical mistake: polling suggests the case against rationing of health care would be as persuasive to Hispanic-American citizens as it is all American citizens. Nobody wants to die waiting in line – especially not behind someone who snuck in ahead of us.

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