Monday, August 07, 2006

Assimilate, or Die . . . Literally

Nearly 20 percent of U.S. residents speak a language other than English at home. According to Mark Hyman, though, it’s “absurd” to suggest that hospitals that serve non-native English speakers should provide translators to ensure accurate sharing of information between patients and caregivers.

his editorial on the topic, Hyman cites a recent essay in the New
England Journal of Medicine that suggests just this. What irks him in particular is that the essay concurs with a ruling by the Clinton administration that access to interpreters is a right ensured by the Civil Rights Act of 1964 that includes a prohibition against discriminating against people based on race and national origin.

Not so, according to Hyman, who notes that there isn’t a single word about medical translators in the 1964 act. Responsibility for language problems lies with the non-English speaking patients, not the hospitals that serve them. Providing interpreters for patients is “impossible” and helps explain why “health care costs continue to skyrocket.”

In addition to the dubious ethics of Hyman’s argument, there are two basic argumentative problems with it. First, Hyman uses the red herring of “skyrocketing” health costs, attempting to link this to the issue of hospitals providing interpreters.

I don’t know about you, but I think Hyman needs to provide an interpreter to explain how the language issue is linked to rising health costs.

And in fact, it’s not. Hyman is simply taking an issue his audience has strong feelings about, the cost of health care, and suggesting without an iota of evidence that the costs of dealing with non-native speakers of English is somehow contributing to that.

Just for kicks, I decided to see how much it would cost to hire a dozen interpreters for every single hospital in the U.S. at $40,000 per year. This is obviously a huge overestimation of what would be needed to provide reasonable support, but that’s the whole point. Even if you insisted that every hospital carry twelve fulltime interpreters, the annual cost would be $2.4 billion.

Sounds like a lot of money, that is until you realize that the U.S. spent $1.7 trillion on health care in 2003. Even with the huge glut of highly paid interpreters I’m hypothesizing, the total layout would add up to 0.14 percent of healthcare costs.

So Hyman’s linkage of interpreters to healthcare costs is a classic example of scare tactics, as well as an invocation of an invalid cause/effect relationship.

The larger argumentative “cheat” that Hyman uses is the old strict constructionist argument that because the 1964 Civil Rights act doesn’t specifically mention a right to a medical translator, the legislation doesn’t apply.

Now, there might be arguments about why the Civil Rights Act doesn’t mandate access to translators when getting medical care, but the simple fact that the act doesn’t specifically mention this is not one of them. Lots of specific rights are covered in the broader language of legislation (see how long it takes an owner of a semi-automatic weapon to invoke the Second Amendment if you suggest such weapons should be illegal).

Moreover, as the author of the NEJM essay points out, hospitals that receive Medicare or Medicaid money are getting government funds. They are therefore obliged to follow federal civil rights law. And if lack of a means of transmitting and receiving crucial information with a healthcare provider because you came from a non-English speaking country isn’t discrimination based on national origin, I don’t know what is.

Does this mean that a county hospital in rural Iowa is obliged to keep a native speaker of Swahili on its permanent staff? Of course not. But hospitals that operate in areas where a significant percentage of incoming patients speak other languages should be prepared to handle the issue. It would be malpractice for a hospital in Alaska not to have the proper equipment in place to deal with cases of hypothermia, and it would be equally wrong for a hospital in east Los Angeles not to have Spanish-speakers on staff to help translate for their patients.

On top of this, having access to personnel who can translate for non-native speakers makes good business sense. It means better, more efficient care of patients, which reduces costs. It also helps guard against malpractice suits that might arise from errors made due to language barriers (and, as the NEJM essay points out, this has already happened).

Ultimately, Hyman’s argument relies on his assumption that his audience will share his xenophobia and callous attitude toward those who are different from them. And it’s this xenophobia that’s the motive behind his argument as well. As mentioned earlier, it’s preposterous to say that the cost of providing translating service for patients adds measurably to the cost of healthcare (in fact, it would probably lower it). Even Hyman doesn’t believe this.

No, the only reason to be as violently opposed to a call for more multi-lingual healthcare services as Hyman is the desire to make things as unpleasant as possible for non-native speakers of English. The unstated thesis of Hyman’s argument is that Americans (at least those who speak English fluently) would be better off letting some non-native English speakers suffer or die because of inadequate language services since it would 1) dissuade foreigners from immigrating to America, and/or 2) force immigrants to assimilate or die (sort of the same threat the Borg make in Star Trek).

An incredibly ugly sentiment. But then again, that’s our Mark.

And that’s The Counterpoint.

Hyman Index: 3.59


At 12:04 AM, Anonymous Herbert Birdsfoot said...

This one is kind of a strange battle for Hyman to pick. Why should conservatives care if hospitals offer translators, as long as they are not run by the government?

Ok, that was a rhetorical question, that Ted already answered. This has nothing to do with the conservative ideology of small government, but is actually just the neo-con "kick down" ideology.

Ted, thanks again for picking apart Hyman's ridiculous commentary.

At 2:56 PM, Anonymous Anonymous said...

With Medicare and Medicaid, the U.S. pays approximately 1/2 of all healthcare expenditures.

Perhaps that is ol' CrabbyAppleton Mark's problem.

But then, could you envision Hyman ever advocating for real health-care cost containment (ie., reform?)


So, instead, he makes a stupid comment about those nasty foreigners.


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