Republicans tried to use the prospect of universal health care as an "immigration magnet" to frighten voters in the summer. That didn't quite work, but the game will turn, and health care will become a patriotic justification for future boondoggles like a Mexican border wall.
The sentiment against health care for illegal immigrants is strong in Washington, and Obama has promised that undocumented workers won't be coddled by a federal system. Republicans argue that undocumented workers will find a way around the system, but whether they do or not — whether a new health system lets immigrants in or blocks them at the hospital door — the pressure on America's idea of itself will be profound.
In Europe, the principle is easy: France is for the French, Germany for the Germans, Britain for the British. Immigrants need a compelling reason to stay. One of America's great strengths is that it's not a nation-state like those old European strongholds of racial tradition, but a nation of immigrants, even if some Americans have a hard time keeping that in mind.
Europe, therefore, has an easier time keeping immigrants out before an argument about health care benefits even arises. Of course it comes up anyway — you can rile an average German by asking how much of his tax money goes to unemployed Turks — but as a rule there's no automatic, existential answer in Germany or France to the question of why an immigrant should be there at all.
Anti-immigrant forces in the States can't rest on the same traditions. Health care would make a reliable fall-back position; the argument that foreigners are "coming here to soak us dry" is easy to make on cable TV. But the logic is backwards, because America is already in far better shape to build a pool of public resources for national health care than any European country, precisely because of its immigrants.
In Europe, the fear of entitlement-soaking outsiders is tempered by a general idea that health care is a universal human right. But because of falling birth rates, most European countries have a welfare crisis to look forward to. America, on the other hand, keeps growing — largely because of its liberal immigration policies. It won't take long for Washington to realize that a rising number of residents is good for any sort of entitlement program. The more people paying in, the merrier.
And then Washington will have to make a decision. Does it continue to let illegal immigrants trickle in but expect them to stagger to an emergency room only when they've been seriously hurt? Does it extend a little medical help to people with no documents at all, on the theory that organized care is cheaper? Does it try to round up undocumented workers, grant them amnesty and get them to pay into the system? Or does it build a Berlin Wall along the border?
The sane, obvious, and time-tested solution, in Canada as well as Europe, is to document the undocumented — clamp down on illegal immigration and make sure newcomers pay into the system. Good idea, but even if the Obama administration largely succeeds, it will change the country.
It will change Democratic rhetoric about immigrants; it will make Immigration and Customs Enforcement, of all institutions, more important; it will revive arguments about "amnesty"; it will make the federal government instantly curious about just which workers in a California vineyard, or a Denver restaurant, are legal. The branches of the economy that rely on illegal immigrants would then have to be overhauled, which might raise wages, along with the prices of everything from housing construction to strawberries.
In general, it will be a sign of health, an indication that the U.S. can still live up to Emma Lazarus' poem on the Statue of Liberty, about the poor and the huddled masses yearning. Because in true, old-guard socialist countries, from East Germany to Cuba, the riddle was always how to keep people in, where they would continue to prop up dinosaur governments. Keeping them out was never a problem.
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