Medical treatment for illegal immigrants is a growing problem complicated and inflated by elements of jingoism, fear, and cultural identity. It is nevertheless just a small subset of this countryâs larger problem of uninsured healthcare. Despite the current political furor around them as election year fodder, the 11 million illegal immigrants distributed around the country represent too small a sample of uninsured indigents to statistically affect the larger problem the individual states confront in caring for all the patients who canât pay their medical bills because they are uninsured.13 Congress, and the insurance lobby, roundly rejected a detailed program for national health insurance in 1994, and no federal official has stepped forward in the years since to propose a plan that will guarantee medical coverage to everyone as a basic human right. Schroeder noted that, âA constant feature of health care in the United States is our national willingness to tolerate having large numbers of people without health insurance. This is in stark contrast to the situation in virtually every other developed country, where guaranteed health insurance is provided either by the state or through employers, with government backup for the unemployed. Whatever the number of uninsured people, we put the values of the entire health care system at risk by accepting their condition as inevitable.â14 At its Board of Delegates meeting in Chicago this year, the American Medical Association recommended that all Americans who can afford it be required to purchase health insurance, with premium surpluses used to support the care of indigent patients. The state of Massachusetts has recently passed landmark legislation requiring that all state residents have medical insurance.15Under the bill, plans would be offered by private insurers but be subsidized by the state. Impoverished residents would have premiums and deductibles fully paid for by the state. Poor but solvent residents would pay at a means-tested reduced rate. Individuals who can but donât buy coverage would lose their personal state income tax exemption and be charged an annual state fee equivalent to half the annual premium rate of the cheapest available policy. Employers who donât agree to offer health insurance coverage would face fines of about $300 a year per employee, a charge the state expects will raise about $45 million a year. These and other fines and fees would be used to subsidize premium charges for poor and indigent patients. No exception for undocumented foreign nationals was written into the bill, guaranteeing their access to the same health care as legal immigrants and citizens of the state. Community leaders cited the âspirit of generosity and respect for the dignity of the person written into this bill,â acknowledging its soundness as ethical policy. It is a unique and possibly definitive solution to the issues of universal coverage and indigent care without regard to extraneous conditions such as immigration documentation. Although legislation of this sort will not solve the immediate problem of assigning financial responsibility for the care of our patient, it is an excellent application of the principles described in our Option E, and we believe it is an ethical and effective choice. Bertrand Russell captured the essence of the problem well when he stated, âIn America everybody is of the opinion he has no social superiors, since all men are equal, but he does not admit that he has no social inferiors, for, from the time of Jefferson onward, the doctrine that all men are equal applies only upwards, not downwards.â In the receipt of necessary medical care, we cannot allow a social underclass to exist in the worldâs richest nation.