Will "Universal" Health Care for Illegal Aliens in NYC and California Hurt the Shrinking Middle Class?

By Dan Cadman on January 13, 2019

New York City Mayor Bill De Blasio has announced his intention to establish a universal health care plan that would include people without regard to immigration status, meaning functionally that the city — already a sanctuary for many other purposes, including by shielding aliens arrested for criminal offenses — is going a step further by granting health care to illegal aliens.

Not to be outdone, new California Governor Gavin Newsom, replacing Jerry Brown, almost immediately after being sworn in announced that the entire state also would be expanding its coverage to millions of new individuals and families, notably including illegal aliens.

Perhaps from a humanitarian standpoint, these are laudable goals, but as with all such plans, harsh reality intrudes.

First, we are constrained to ask: Who is going to pay for these services? They are, after all, reminiscent of newly minted democratic socialist House Rep. Alexandria Ocasio-Cortez's proposal for nationwide universal health care, which was immediately panned as being too costly — somewhere in the neighborhood of $32 trillion, as I recall. She has suggested that one way to handle that would be to establish marginal tax rates escalating as high as 70 percent for the highest-paid in the country.

We may generically dislike the notion of robber baron-like multibillionaires such as Zuckerberg or Bezos even as we dream of being one of them, but I doubt that there is any stomach in our country for such Soviet-like tax burdens on the hyper-rich to create overweaning health bureaucracies. I'm no fan of our current system — it has entirely too many cracks through which people can fall — but I also have a horror of a nationwide health care bureaucracy, which, once established, would work with the same splendor as the VA health care system, only on steroids.

Of course, a city or state's fiscal burden would be less than one for the entire country, but then so is their available funding. I have no doubt that both the cities and states would do everything possible to take advantage of available federal funds to help offset costs. How? Easy, because money is fungible. Simply use federal funds in accordance with federal mandates that, in theory anyway, prohibit use for care of illegal aliens except in emergency facilities. But of course this federal taxpayer money frees up at least a portion of the city or state's resources to attend to the new cost burden. This allows the city or state to give lip service to federal requirements and avoid the possibility of "clawbacks" while still moving toward its goal of providing health care to illegal aliens. Federal money wouldn't be enough to cover full costs, however. So where would the remainder come from? There are only so many zillionaires to tax, which inevitably leaves the middle class of that city or state to carry much of the burden.

This leads us to the next question: What is the impact of such a plan? It will no doubt act as a beacon to many aliens who have no status or health coverage, and want it. Why would it not incentivize a relocation to the city or state, especially in the hermetically sealed environment of a "sanctuary"? As more aliens arrive and seek services and coverage, costs will rise, and new tax burdens will have to be levied for the "unexpected" costs. The inevitable result will almost certainly be a shrinking, if not collapse, of the middle class, either because they are driven into poverty trying to compete against cheap wages, or because they relocate to other cities or states with lesser tax burdens and more affordable living circumstances.

Large chunks of California have already seen this phenomenon to some significant extent. Witness Silicon Valley, the San Francisco Bay area, and other tony environs. They are left with a two-tier structure: the extraordinarily comfortable who can afford the cost of living, exorbitant housing prices, taxes, etc.; and the service class who wait on them— literally — as nannies, short order cooks, gardeners, handymen, building maintenance workers, hotel housekeeping staff, you name it, these workers often being aliens without status. Many of them live substantially below the poverty level (see here and here).

There is no such thing as a free lunch, and in the end, neither is there such a thing as free health care.

The question to me is as much a moral as an economic one: Should the United States be reliant on a continual underclass of illegal aliens working in menial or unskilled positions — thus depressing wages for the native-born — in order to sustain a way of life for those wealthy enough to take advantage of them, even while ameliorating their guilt with such proffers as universal health care to the underprivileged and poverty-stricken? Doing so only ensures the continued stagnation and compression of what was once a burgeoning middle class.

I suppose it all depends on the prism through which you look, but to me that is not a desirable future and, while many progressives will balk at such a dystopian description, is that because it's inaccurate or because it gets too uncomfortably close to the truth?