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Damn if you do and damn if you don't -- WTD w/ undocumented immigrants

Discussion in 'Topics in Healthcare' started by saradoor, Jul 18, 2006.

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  2. jocg27

    jocg27 Senior Member
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    I saw another post on a similar thread a while ago that really stuck with me...It's funny how the same doctors who whine that "I didn't come into medicine to be a social worker" are often the same ones who are so quick to become INS agents.
     
  3. mzeroapplicant

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    For me personally it wouldn't be a tough issue; doctors have a committment to preserving health that goes beyond the particularities of a patient. Doctors are willing to heal prisoners who have done horrible things too, it's really not a matter of the patients' situation, it's a matter of being committed to preserving the health of human beings. I wouldn't think illegals would be any different.
     
  4. Yes, I agree with you in principal BUT how far are you willing to scarify your own financial well-being to walk the talk? A lot of doctors are self-employed and if you don't get compensated for your work where do you get the money to pay off your student loans? Or should we use a Robin Hood scheme to rob the legals to aid the undocumented (which seems to be the current implicit federal solution)?
     
  5. cfdavid

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    That's great in individual situations, where a specific doctor may be willing to do a certain percentage of pro bono work. But, we're talking about an unprecidented number of new immigrants (currently, the concern is with illegal immigrants) that will have a major impact on our healthcare system. Some may argue a negative impact since there are ability to pay concerns, over-utilization of emergency services etc. But, SOMEONE must pay. Perhaps we'll need to have a national dialogue. However, I think that the majority of Americans won't be quite as generous as some may be here.

    Eventually, there will be a day of reckoning, since no institution can operate perpetually in the red (and this includes hospitals and clinics). There's a reason for a policy of "metering" specified numbers of immigrants coming into the country. Historically, because most immigrants came over on boats that landed at Ellis Island, it was easier to enforce whatever immigration policies were on the books at the time. Illegals were less of a problem since the Atlantic Ocean is quite an obstacle. But, it's a huge problem when people just walk into the U.S. from Mexico, undocumented.
     
  6. Chinorean

    Chinorean Senior Member
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    Even if the doctor offers his services for free, the cost adds up for the hospital. That's time spent where the doctor could have been helping someone who can pay. That's a hospital bed taken away from an American citizen. Plus the treatment may also involve supplies--some cheap and some not so cheap. If you think of it in terms of one person, it's not a big deal. But if it's hundreds and a problem in many cities it becomes a bigger deal.

    Personally I don't like the idea of turning someone away in need. And it also may lead to racial profiling--"oh you're Mexican? Prove to me you're a citizen. What do you mean you don't carry your passport with you when you're on your way to the bowling alley, you should have known a drunk driver would hit you" etc. etc.

    Maybe hospitals could work out a quota system where a number of unpapered patients could be seen, based on what they can economically afford to handle.


     
  7. or someone who is in this country LEGALLY...

    I think this is our system now but I think the sharp increase in undocumented visitors are just too much for a few states in particular to handle.
     
  8. mzeroapplicant

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    Many things you're saying are true of ALL poor Americans, I live in a major city that is typical: ERs are flooded with low income workers (citizens and non-citizens alike) who use the ER as primary care. It's important to keep in mind that because illegals pay taxes but don't (usually) receive medicare, medicaid, etc., to a certain extent illegals are subsidizing health care in this country that isn't going to pay THEIR medical bills.

    Also, the more doctors and hospitals do make this an issue, the less willing illegals are to seek help from the medical community. Now I'm sure there are some of you who could coldy say "I don't care, they're here illegally", but when a 10-year-old kid dies from a preventable disease because somebody couldn't risk taking him to the ER and didn't find a discrete doctor in time, MOST of us have the humanity to say that that isn't right.
     
  9. BozoSparky

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    wow...difficult subject. personally, i could not refuse an illegal immigrant health care. i have been very fortunate my entire life and have never had to feel like an outsider, but can you imagine what it's like to arrive in this country with nothing but the clothes on your back? ...hoping for a better life? that said, i don't want our system to be a get-what-you-give type deal...it could be better than that, helping those who don't have the means, including illegal immigrants (a.k.a human beings). my view might not be practical on paper, i'm sure...i'm no economist, but i just feel that if someone struggled to get across the border in order to have a better life in this country, and made it, we have to take care them. to deny care, would be perhaps the most selfish thing i can imagine, considering our collective wealth. i do not think we should carry the border into our hospitals and clinics. keep it where it is...and deal with immigration at the physical border itself.
     
  10. t33sg1rl

    t33sg1rl Senior Member
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    As a legal immigrant, I really hate the problem of illegal immigration. My family fought with the INS for years getting our paperwork through... where we lived, they didn't give appointments, so my parents kept us home from school over and over, so we could go downtown at 7 am, take a number, and sit all day to talk to someone in the late afternoon. I do resent people who decide to just skip all of the hassle and enter the country illegally. Get in the back of the line, like I did-my personal solution? A child born in the USA to two illegal immigrants should NOT get citizenship-it should be a citizen of its parents' country ONLY. People would stop crossing the border all but overnight.

    But as far as providing medical care to illegals? I think that standard and reasonable medical care is a basic human right, and we have to keep caring for ALL patients, regardless of ability to pay, until the hospital files bankrupcy and closes its doors-and when that happens, we'll start making house calls.
     
  11. BozoSparky

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    Hmm...I suppose I can understand that you resent those who come illegally, considering all the trouble it has given you and your family. I do not mean to take away from your experience. But I think one difference in the case of an illegal immigrant is a complete lack of resources or connections to enter this country in a legal manner. I'm sure if you compare the education and monetary resources of legal versus illegal, you'll see a very large difference.
     
  12. Learfan

    Learfan Machine Gunner
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    Real simple answer. If someone is illegal then absent a legal requirement to assist with a life threatening emergency no care of any kind should be rendered. This would reduce a problem that threatens to bankrupt our system.


     
  13. jocg27

    jocg27 Senior Member
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    What you're saying is true. Legal immigration through our current process is a ridiculous series of hoops to jump through.

    What bothers me is the idea that these laws come down from on high, we must take them as they are.

    I hate this idea that "I'm not against immigration, I'm against ILLLLLEEEEEEGGGGAAAALLLLLL immigration." I find this to be a copout. These laws are made by and for us. IF you are TRULY only worried about the letter of the law, and if you really agree that legal immigration in its best form, families coming here to work hard, improve their lives, and contribute to this country is a good thing, we should be making it easier to come here, not harder. We should wipe out some of these ridiculous draconian laws and tomes of forms that make it such a arcane process to come here legally. As the post above makes clear, there are good families who want to come here for the right reasons and once they got here they would be able to improve their lives, this country, and perhaps even their country of origin...but they can't even get here, because we make it so insanely difficult. (Just to cut off an argument before it even comes out, I am sure someone out there is saying 'so we should let them come here so they can send money back to Mexico and improve Mexico?' I find that a double standard. How much has been said recently about the surging economy of India? You're telling me India hasn't benefitted from a diaspora of immigration economically succeeding around the world? )

    Anyway, I am not talking about throwing open the borders let everyone come and go when they want. I am talking about a humane, reasonable, understandable, and logical immigration system that treats humans like humans. Then all the people that say "I am in favor of immigration but against ILLLLLLEEEEEEEEEGGGGGAAAAALLLLLL immigration" SHOULD be fine, since they claim to understand and agree with the good aspects of immigration, but try to argue they are only worried about the letter of the law.

    Yes, it is a huge hassle to come here, as you say. Yes, people should come by legal means. But to complain so much about how people don't think its fair that legal ones go through immigration while illegals skip to the front very much sounds like (this'll be fun, I bet I get flamed horribly...but I still find it to be true) old school attendings complaining that they had to have 130 hour weeks as interns, so everyone who comes after should, too.

    No, it's not the same? Why exactly not? A matter of safety, lives are hanging in the balance in the hospital? Tell that to the people who die of dehydration or violence in the deserts near the border.

    Sometimes things change, the world changes. Neither immigration nor medical training should be like hazing, and if we can change it (we live in a democracy, we can), then we should. We did change the laws regarding residency, and now the only people who think the old way was good are the people who are bitter that they had to do it and now its gone. Current immigration law, like that old practice of working residents like slaves, is outdated, impossible to defend or understand, and yet so difficult to change because the people who have done it think everyone should.
     
  14. cfdavid

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    It seems you've just contradicted yourself in a pretty big way. On the one hand you admit that poor people (illegals included) overutilize very costly emergency services, yet in the very next sentence you indicate that illegals are somehow benefiting everyone else in that they help "subsidize" our healthcare system. Which is it?

    Regardless, your arguement would have some merit if it wasn't a fact that illegals DO get sick, and when they do, they also DO get care (usually through the ER) or some other truly subsizided (privately or publicly) clinic.

    My point is that the buck has to stop somewhere. So, we better get a handle on these issues unless we want to see a bankrupt system.
     
  15. Jon Davis

    Jon Davis I killed the bank.
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    This is complete garbage. You're making excuses for illegals to come to America based on their financial situation. Make the American tax payer pay for the illegals that can't find work in their own country. What a great philosophy.

    Mexicans live in a democratic nation. If they have a hard time finding jobs, why not vote for someone who is commited to fixing it? I blame the Mexican government for encouraging illegal immigration. Their economy relies heavily on dollars coming back to families in Mexico. If anyone is interested, I'll pull up research to back this up.

    What I find interesting is that a North American Union is in the works. This might be the magic bullet that politicians might use to solve the illegal problems. I think it's complete horse ****! Check out out yourself. A prioritized resolution was signed by Bush, Fox and Martin in 2005 to get the wheels rolling. Will it succeed? I hope not. Dear God, I hope not.
     
  16. cfdavid

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    I think it's perfectly o.k. and valid to support a sensible immigration plan, yet be opposed to illegal immigration. There IS a difference. It's simply not sustainable to have thousands of people just walking (climbing.. whatever) over the border every day.

    Perhaps we need to reevaluate our immigration laws. However, that very well may conclude that we need to tighten up the system, and not necessarily open up an already very generous policy towards immigration in general. Unfortunately, politics and political jockying is preventing our congress from taking on this heated debate.
     
  17. jocg27

    jocg27 Senior Member
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    Then there's this idea of they're going to bankrupt our 'system.' Cmon now...Is there some additional strain on some social services? Sure...translators have to be hired, this and that, I can buy all that. But you cannot convince me that their overall economic effect on this country is negative. If every undocumented immigrant disappeared, we'd be worse off, not better.

    I believe, and plenty of studies show, that all types of immigrants, documented and otherwise, strengthen our economy. So what's this mean? Do economic reasons like this justify breaking laws or the acceptance of breaking laws? No, of course not.

    But as I said, an understanding that our current system is broken, and understanding the economic and humanitarian benefits of a more open immigration policy can justify changing laws...
     
  18. Jon Davis

    Jon Davis I killed the bank.
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    They do put a huge strain on our social services. They enroll their kids in public schools, use the ER like their personal clinic, use public facilites intended for the tax payers, they don't contribute to social security, they keep wages artificially lower. I can go on and on. You're thinking inside a small box my friend. The web is HUGE.

    In addition, the President says they do jobs Americans won't do. This is wrong and a huge lie. What the President leaves out is that americans don't take them because they pay below jobs of similar work Americans do take. Thus, if there is a labor market willing to work at a lower wage of course there will be those that take in illegals. This illegal immigration can be killed by taking vigilant action against companies that hire illegals.
     
  19. BozoSparky

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    Jon, I understand what you are saying and I didn't mean to annoy you, but how many wealthy, politically savvy, illegal aliens do you know? Being poor is not really an excuse, it's a real reason people want in. It's not a philosophy.
     
  20. cfdavid

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    I didn't know money just grew on trees. Why is it so hard for you to understand simple economics?? At the very medical school I'll be attending in 2 weeks, the new CEO (of the school affiliated healthcare system) has not signed an agreement with the schools physician group. The reason is because the medical system is in a poor, urban area, and they just can't continue operating in the red. And a large part of the problem is the inability of those hospitals to capture fees from too large a percentage of people that they provide care for. But, maybe you and your buddies can volunteer to work for free so that they may not have to cut more residency programs in order to turn things around!

    Again, the point is that simple economics dictate that the buck (pun intended) must stop somewhere. Someone must pay. Unless, that is, people suddenly become willing to work for free or substantially reduced wages, and that includes staff, suppliers, and even the contractors that built the hospitals in the first place. But, in reality, eveyone expects to be paid.
    Like another poster has stated, you're not seeing the bigger picture.

    Sure, new debt can be floated, but that's just passing on a problem to be dealt with in the future, and at a price mind you.
     
  21. mzeroapplicant

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    It's not a contradiction: illegals do overutilize the ER system as much as other poor communities, the difference is that they're providing a substantial subsidy by paying taxes and not getting most of the health benefits that other poor populations get from those taxes. Yes they are draining the system, but because of the substantial offset (from paid taxes, no benefits) they aren't draining the system nearly as much as poor citizens do.

    A path to legalization would provide a great way to solve many of these problems, however: illegals who are already here would be more concerned about future credit ratings, have more of a sense of investment in their identity, etc, if they knew they had a path toward being a citizen who could one day buy a house, business, etc. I'm not saying they would pay off all their outstanding medical bills right away or any pipe dream like that, but people who know they are going to be citizens of this country will be more invested in their credit in the long term.
     
  22. cfdavid

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    o.k. you make some good points. but, i'm not going to advocate an open border (not that you are). i'd be more supportive of a guest worker program versus amnesty for those that broke the law (and yeah, i do realize it's not the same as robbing a bank). maybe the guest worker plan could be the venue by which citizenship could ultimately be attained, over some specified period of time. and in the meantime, they could be paying into a system that they would have access to even as a guest worker.

    also, generally speaking, our nation's in need of a dialogue regarding healthcare. we have a super large demographic that will be requiring more health services that ever in our history. and when those cost become their reality, trust me, this will become an issue.

    my personal thoughts are that we must do everything possible to keep costs in check. and that might mean practicing more preventative and smart medicine. but, it also may simply mean that we all must accept that a higher percentage of our GDP (and individually, disposable income) will go towards healthcare.
     
  23. tncekm

    tncekm MS-1
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    Agreed. I am an avid supporter of putting a stop to illegal immigration and to holding accountable those who supply jobs to illegals to cut their bottom lines with tough law. I also support the recent legislation passed by Colorado that would deny treatment to a large sect of the illegal population by requiring they supply proof of citizenship at the front desk. In addition, I'm also a supporter of capital punishment without the cruel and unusual punishment protections! One would think those facts woudl be at odds with my position on the matter of treating illegals and other patients, such as dangerous prisoners, as you mentioned earlier.

    BUT, as a doctor you are bound to preserve life and health to the best of your ability and as a person I would never be able to deny treatment to anyone in front of me who needed medical attention (lets not do hypotheticals- i'm sure there would be some exceptions). This is a very complicated problem for medical and health professionals IMO. I believe society should reward and repriment people a certain way, but I also believe that each professional and societal contributor should do their best to do their part. So, if I'm not going to treat illegal immigrants we will have to keep them from entering the country and make the rest leave by denying them job opportunities. It is a situation I would prefer, but so long as they are here, I would never personally deny them treatment. In the health profession, people often have to save the lifes of other people whom we would probably strongly dislike and save the lives of people whom we may believe ought not be here in the first place. I'm sure that similarly, every judge has to punish a person he believes had "moral" legitimacy to his/her actions, etc.

    I hope my attempt at explaining my position was semi-successful. I'm sure its probably hard to follow. I know its very hard to communicate at times.
     
  24. tncekm

    tncekm MS-1
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    They don't pay "taxes". They pay sales tax only for a great part of the population and some with fake papers will have some removed via payroll services but thats hardly what I'd call a "substantial subsidy" considering their average earnings are so low.

    Their detrimental effect on our society, specifically the health care system, can easily be seen by the dozens of hospitals being forced to shut down in California as a result of services performed on illegals (mostly childbirth services) which are never paid.

    Also, on a side note I come from a very blue-collar family and I was involved in construction my entire life. Anybody who tells you that illegals didn't undercut their way into the workforce is misinformed (which I can't blame them for. According to our news services and disgusting politicians such as John McCain Americans won't do any of the jobs today that they prodominantly performed only a few decades ago. *rolleyes*)
     
  25. mzeroapplicant

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    I believe it's a bit deceptive to simply say that "some" illegals have it removed from payroll taxes. Yes, there are some migrant workers, day laborers, and childcare workers that don't contribute payroll taxes, but if you consider *just how many* illegals are in this country, the vast majority of them use fake ids to get legit tax paying jobs. Payroll taxes really do subsidize these programs.

    I agree that in areas like construction and many service jobs, illegal workers did cause wages to be cut (this should be pretty obvious). In other areas of the economy (i.e. goods), those jobs would have been moved to Mexico if illegals hadn't showed up to work for less, so if anything, it allowed some citizens to continue being employed in those domestic businesses alongside the illegals.

    Most importantly, we can't go in reverse, the high paying jobs aren't going to magically appear now no matter what we do. I'm not advocating open borders, but they're here, and we need to find a sensible way to deal with it.
    Also, the effects of illegals on the economy are enormously complex, we don't complain that our goods and services are cheaper, that we're able to get things more cheaply. Many businesses don't ask a whole lot of questions even if they know someone with a fake id is probably illegal, so they're also culpable. What I'm saying is that there are many guilty parties in this whole social problem, but I think punishing some kid who is a sick and needs to go to the ER won't be an especially good solution.
     
  26. Jon Davis

    Jon Davis I killed the bank.
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    The first bolded paragraph makes no sense whatsoever. How can you say that those jobs illegals do would have been outsourced anyway? Are you out of your mind?!!?!?

    The second bolded paragraph I agree with somewhat. Business operators must be held accountable. I would even support charging them with treason.

    Official definition of treason:
    1. Violation of allegiance toward one's country or sovereign, especially the betrayal of one's country by waging war against it or by consciously and purposely acting to aid its enemies.
    2. A betrayal of trust or confidence.

    Those illegal immigrant loving businesses fit both criteria. These businesses are harming America by aiding people to cheat the system and the country's tax paying legal residents and citizens. The second part is pretty much straight forward. It pisses me off to no end.

    BTW, its not about punishing anyone. Its about protecting our hospitals from being raped of resources it knows can't be compensated for. Get it right.
     
  27. tncekm

    tncekm MS-1
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    I don't find it to be deceptive at all. Again having grown up in blue-collar America with lots of self-employed family and friends, I can unfortunately say I've witness that as often as possible illegals are paid under the table. Only in a corporate environment will payroll be mandatory- and that's simply because they want to track every penny that moves through their business since there is nobody with hands on everything.

    I'm sure most of you have an idea of how our progressive tax system works. The more you make the more you lose (unless you make wise investments, which I'm sorry to say is not a common trait of my fellow Americans). Here is a nice illustration of Income with respect to citizenship provided by the Center For Immigration Studies (I know some people will try to bash them, but they do good work in my opinion):

    [​IMG]

    I don't want to argue about "why" the income differences exist, its obvious enough, but I do want to point out that with such little annual income and wth a large portion of illegals working under the table, I would hardly count their contribution to our tax system as justification for the fact that they are responsble for a major abuse of our public services, often leading to a loss of those services as can be seen in California with the closing of dozens of hospitals over the past few years.

    You're right here. There is an inherent risk involved with this move. However, I'd argue that we'd be just fine. We managed to function before the wave of illegal immigrants as a result of the Bush amnesty and we can manage again. Some businesses will close, others will simply make less profit, and others (such as our hospitals and other public service entities) will benifit from this.

    We do need to deal with this, and IMO, dealing with this involves harshly opposing policy that supports allowing illegal immigrants to take advantage of us.

    there is a humanitarian crisis here, however, that needs to be addressed. but, it just isn't possible for the US to bear the brunt of every humanitarian crisis that exists in the world. we have a large native population that needs our attention first and foremost.
    If the recent rise in gas prices has told me anything its this. If we happen to undergoe some increase in cost of living for a cause that most of Americans support, the bitching will be minimum and we'll be able to bear it.

    I agree 100% with this. I would never punish someone who is here and who needs our help and is in serious condition. And, as I stated above, I agree there is a large humanitarian crisis. But, its mexicos problem primarily. I'm hopefuly their new president, who openly stated he is embarassed of the politican and social environment in mexico (a nation rich in resources and with large support from wealthy nations). Maybe, just maybe, he can start making a change.
     
  28. What do you think of the argument that by providing accessible non-emergency health care to the undocumented, the health care profession actually contributes to the problem (i.e., more are willing to risk their lives to come because they know health care will not be an issue)?
     
  29. Jon Davis

    Jon Davis I killed the bank.
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    I'm getting suspicious. I've seen hundreds of threads where the OP posts one statement, and doesn't appear again only to propose another argument. Usually these guys have low post counts.

    Is this some essay you're writing? I think I've done more than enough. :laugh:
     
  30. EvoDevo

    EvoDevo Forging a Different Path
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    Moving to the Topics in Health Care forum...
     
  31. The best way to figure out if the OP is phishing for essay ideas is to look at his/er history (left click on his name and go to "Find more posts by ...") :)
     
  32. tncekm

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    I agree, to an extent. Along the border its an issue. We even have ambulances coming in from Tijuana driving directly to american hospitals :rolleyes:

    But, for the most part, I don't think it has much to do with the mass immigration we've seen. its all about money.
     
  33. The thing that really bugs me is how the illegal immigrants are being treated by the Mexican government: http://www.washingtontimes.com/national/20050324-121935-8473r.htm

    excerpt:
    "...
    Many of the illegals in Mexico, who emigrate from Central and South America, complain of "double dangers" of extortion by Mexican authorities and robbery and killings by organized gangs.
    The State Department's Human Rights Practices report, released only last month, cites abuses at all levels of the Mexican government, and charges that Mexican police and immigration officials not only violate the rights of illegal immigrants, but traffic in illegal aliens.
    Although Mexico demands that its citizens' rights be protected when they illegally enter the United States, immigrants who cross illegally into Mexico "are often ripped off six ways until sundown," says George Grayson, a professor at the College of William & Mary and a fellow at the Washington-based Center for Immigration Studies (CIS).
    ..."

    and http://www.msnbc.msn.com/id/13006798/site/newsweek/

    excerpt:
    "...
    Mexicans may hate the new U.S. plan to deploy 6,000 National Guard troops on the border, but five years ago they cheered President Vicente Fox for sending thousands of Mexican soldiers to crack down on their southern frontier.
    ..."

    I guess those poor folks can forget even the emergency care in Mexico!
     
  34. travis

    travis Member
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  35. tncekm

    tncekm MS-1
    2+ Year Member

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    Great post saradoor.

    I wasn't suprised at all when I first heard this just disgusted at how it is hidden in the media for the most part.
     

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