|
Robert B. Sklaroff, M.D.
|
TESTIMONY
HOUSE MAJORITY POLICY COMMITTEE HOUSE OF REPRESENTATIVES COMMONWEALTH OF PENNSYLVANIA PUBLIC HEARING
Representative Mario J. Civera, Jr., Chair
July 27, 2006
By Robert B. Sklaroff, MD
Regarding:
HOUSE BILL No. 2761[PRINTER’S NO. 4220]
The Protection of Public Benefits Act
*
AN ACT
Limiting expenditure of public moneys on illegal aliens; and providing for requests for reimbursement of public moneys expended on illegal aliens.
“No public moneys shall be expended on, and no public benefit shall be provided to, any illegal alien [‘a noncitizen of the United States who is within this Commonwealth and who is in violation of Federal immigration laws’] with the exception of expenditures for: (1) emergency medical care; or (2) law enforcement, prosecution, incarceration and related expenses.”
*
Robert B. Sklaroff, MD, FACP Suite #130 50 East Township Line Road Elkins Park, PA 19027-2253 (215) 663-8200 FAX: (215) 663-8388 e-FAX: (215) 689-2461 http://www.doctor-bob.biz
Representative Civera, and Committee-Members:
I am Robert B. Sklaroff, MD and I am testifying on behalf of myself. I am a Jewish physician and, therefore, will address the professional ethics that underlie this Bill. Specifically, I will explore both the religious and medical underpinnings of this proposal. I am a student at Gratz College, a multi-denominational school in Melrose Park, seeking a Masters Degree in Education. I am a former member of the American Medical Association, and I wrote literally hundreds of resolutions at all levels of organized medicine during the decade of the 1990s before I resigned therefrom for political reasons. Also, I am a past-President of the Pennsylvania Society of Internal Medicine, which has been folded into the American College of Physicians, and I am currently continuing to pursue litigation that was initiated by the PSIM in an effort to split the “Highmark” monopoly back into Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania.
My goal is twofold. First, I will refute arguments promulgated by the Jewish Council for Public Affairs, which is a national coalition of religious groups that is now lobbying “to allow undocumented immigrants legalization opportunities.” Second, I will demonstrate that the contemplated method of funding urgent medical care is consistent with the AMA’s Council on Ethical and Judicial Affairs. In both realms, I do not pretend to be an expert; my goal is to convey a database that will serve to provide a comfort level for those who favor passage of this bill. If any questions require further research, I will provide necessary information. Appended to this Testimony are the AMA’s Principles of Medical Ethics and all immigration-related policies cited from its web-site [http://www.ama-assn.org]. The Principle that is most-applicable to this legislation is “VI”: “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” Thus, none of the Principles are violated by H.R. 2761.
Of the six policies that relate to immigrants, the only policy that addresses the delivery of medical care to undocumented immigrants [D-440.985] states that: “Our AMA shall assist states on the issue of the lack of reimbursement for care given to undocumented immigrants in an attempt to solve this problem on a national level.” Thus, none of the Policies are violated by H.R. 2761.
In addition, the web-site of the Pennsylvania Medical Society advises physicians as to how they may comply with provisions of the Deficit Reduction Act of 2005, which included a series of changes to Medicaid coverage and eligibility rules. The new law requires that every individual declaring to be a citizen or national of the United States seeking coverage under Medicaid provide “satisfactory documentary evidence of citizenship or nationality.”
Therefore, recognizing that physicians must never refuse to provide medical care on an emergency basis, that component of this bill is consistent with the policies of Organized Medicine.
The initial provocation for generating this Testimony was based on having read of the creation of a national coalition that advocates allowing undocumented immigrants to be afforded legalization opportunities. Appended to this Testimony is a copy of the news-article that details this effort. I feel the priority should be to secure America’s borders, but it was necessary to discern the Biblical foundation for this naturalization policy, if indeed one existed.
Classically, the importance of helping strangers is derived from Genesis 18, when Abraham embraced the three angels. Indeed, the Talmud, which is a book that was written in the Common Era to serve as a commentary to the Torah—which includes Exodus—says: “Hospitality to wayfarers is greater than welcoming the Divine Presence.” [Babylonian Talmud, Shabbat 127a]
Benjamin Franklin composed his “Parable against Persecution” on the following parable: “Once, however, Abraham’s love of strangers clashed with his zeal for God. He invited a wayfarer to his home and, finding him praying to his idol, chased him away. God reprimanded Abraham severely: ‘I have borne with him these many years although he rebelled against Me, and you cannot bear with him one night?’ Abraham realized his sin and did not rest until he had brought the stranger back.” Thus, it is vital to honor the philosophies of your guest over those that you harbor, it is that important to assist the stranger in your midst.
Notably, also, the Torah contains numerous references to helping the needy. Commentators have concluded that, because each human being is created in the “image of God,” showing hospitality to strangers is a way of welcoming God into our lives. In addition, in a reference-text published by the Reform Movement written by Harvey J. Fields, the discussion is continued thusly: “When it came time for his guests to leave, the commentator Nachmanides comments that Abraham did not just bid them farewell at his gate, but he went with them until he saw that they were safely on their way.” It must be appreciated that they were not invited to remain in his tent. Granted, there was no country yet established in the Promised Land, so this could not have occurred in the Jewish Homeland. Nevertheless, it was clear that the strangers were not expected to linger.
On the other hand, Abraham’s treatment of the strangers was contrasted with that of Lot, and we all know what happened to Lot’s wife after the destruction of Sodom and Gomorrah. Indeed, according to the Spanish Jewish interpreter Abraham ibn Ezra (1092-1167), not one citizen of Sodom protested the cruel treatment of strangers. Such indifference to evil—instead of opposition thereto—condemned the entire city to destruction…although more “evils” co-existed. They chose cruelty over charity, selfishness over caring, and greed over sharing.
American society is not guilty of these sins, for it continues to honor a tradition of maintaining a social welfare safety net. And invoking the ideas inherent in the Immigration Reform proposal of Representative Mike Pence (Indiana – 6), illegals wishing to become citizens would first have to return whence they came. It is apt to consider the approach to warfare and the method by which gentiles were included in the Jewish Community. Regarding the former, enemies were always offered the opportunity to avoid bloodshed and, regarding the latter, even miscreants traveling in the Sinai desert for 40 years were included in the group. The exception to the former was only the prior inhabitants of Canaan, for their continued survival was felt to be risky as the new nation was being established. The exception to the latter was only those who actively rebelled against Moses, for they were inherently challenging the Covenant that ultimately yielded Israel.
The rest of the Jewish Bible—the Prophets Nevi’im and the Writings Kethuvim—contains stories about how Jews treated, and were treated by, their neighbors. Again, in no instance did the Jewish People oppress strangers. Indeed, the new system of Justice did not permit favoritism in any dispute to be granted to Jews, or “Hebrews” or “Israelites,” as they were depicted to be at that time. There was a recognition that the Gentile, the Ger, was different, but there was no effort to convert them to Judaism so as to integrate them forcibly into the Jewish People.
Thus, when the Promised Land—Judea and Samaria—had become inhabited, aliens had no special rights beyond being treated hospitably…prior to departure. Similarly, the Commonwealth of Pennsylvania should be duly hospitable when it is urgently necessary to help strangers—particularly medically—but it should also feel no compunction—later on—when it is necessary to usher them out the door. Such a policy reflects the absurdity of any need to accommodate all humanity. Thus, there is no mandated permanence taught here; in fact, Moses Maimonides (1135-1204), the great physician-philosopher, taught that the highest level of charity was teaching self-sufficiency. Thus, after having cared for the strangers’ emergency need for rest and sustenance, Abraham facilitated their departure.
Thus, passage of this bill—a copy of which is appended—is consistent with the ethics of medicine and the morality of our Judeo-Christian culture. One final point is important to emphasize. Through the good offices of Ms. Erica Godsey, I was able to read all of the prior written-testimony provided to yourselves regarding this issue; none of it relates to the two critical criteria that prompted this submission.
Again, please feel free to contact me if there is any question that requires further research.
Appendix I AMA Principles of Medical Ethics and Policy Compendium Excerpts
The AMA’s “Principles of Medical Ethics”—adopted by the House of Delegates on June 17, 2001—are as follows: Preamble The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician. Principles of medical ethics I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. IX. A physician shall support access to medical care for all people. [http://www.ama-assn.org/ama/pub/category/2512.html]
http://www.ama-assn.org/apps/pf_new/pf_online
Appendix II Jewish groups join coalition lobbying to legalize immigrants By Ron Kampeas
July 14, 2006
WASHINGTON, July 14 (Jewish Telegraphic Agency) — Jewish groups joined a broad, faith-based coalition lobbying Congress to allow undocumented immigrants legalization opportunities.
Jewish speakers said Jewish history and tradition compel compassion in dealing with illegal immigrants.
“Over and over again the Torah emphasizes that we must treat the stranger decently, with love and with fairness,” Steve Gutow, the executive director of the Jewish Council for Public Affairs, told the group of about 150 clerics and faith leaders prior to their lobbying sessions Wednesday.
The coalition, representing dozens of Christian, Jewish, Muslim and Sikh organizations, lobbied an array of lawmakers from both parties.
JCPA, the umbrella organization for community relations councils; the American Jewish Committee; the Religious Action Center of Reform Judaism; the Hebrew Immigrant Aid Society and a number of other groups oppose existing U.S. House of Representatives legislation because it focuses almost exclusively on punitive measures.
Sen. Sam Brownback (R-Kan.) said advocacy for undocumented immigrants could use faith-based support to counter the strides made by groups seeking tough measures against illegal immigrants.
“It is important for this group to raise the theological debate,” Brownback told the group, adding that there was a need for “compassionate voices.”
Rep. Howard Berman (D-Calif.), who has dealt with the issue since becoming involved in the farm workers movement in the 1960s, invoked his own Jewish history in explaining his involvement.
“My religion, Judaism, was a big part of what got me into this,” he said, describing his father’s arrival from eastern Poland in the 1920s. “It’s very hard for me to turn my back on this.”
The coalition advocated opportunities for illegal immigrants to attain legal status “upon satisfaction of reasonable criteria;” the reduction of waiting times for family reunification; and border protection policies “consistent with humanitarian values.”
The coalition represented a wall-to-wall array of political views, from evangelical Christians on the right to liberation theology Catholics on the left.
“We’re here today presenting a united front along interfaith lines, groups that might have different perspectives on other issues, but are united on this issue,” said Brooke Menschel, the American Jewish Committee’s assistant legislative director.
Menschel said the Jewish component was especially important, because opponents of accommodation of illegal immigrants often cited border security in demanding toughness.
Jews are probably more sensitive than any other group to security needs, Menschel said, and present a powerful voice in arguing for humanitarian border security measures.
“Legislation that is piecemeal or less understanding will ultimately be bad for national security,” she said.
http://www.jta.org/page_view_story.asp?intarticleid=16823&intcategoryid=3
Appendix III The Proposed Legislation
http://www.legis.state.pa.us/WU01/LI/BI/BT/2005/0/HB2761P4220.HTM
PRINTER’S NO. 4220 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL No. 2761 Session of 2006 INTRODUCED BY METCALFE, CREIGHTON, ALLEN, BALDWIN, BARRAR, BASTIAN, BELFANTI, BENNINGHOFF, BIRMELIN, BOYD, CALTAGIRONE, CAUSER, CLYMER, CRAHALLA, DENLINGER, ELLIS, FLAHERTY, FLICK, FORCIER, GABIG, GOOD, GOODMAN, GRELL, GRUCELA, HARRIS, HICKERNELL, HUTCHINSON, KAUFFMAN, M. KELLER, KENNEY, MAHER, MAITLAND, MILLARD, R. MILLER, MUSTIO, NAILOR, PYLE, QUIGLEY, RAPP, REED, REICHLEY, ROHRER, SATHER, SCHRODER, SOLOBAY, SONNEY, R. STEVENSON, TRUE, TURZAI, WOJNAROSKI, WRIGHT AND YEWCIC, JUNE 14, 2006 REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES, JUNE 14, 2006 AN ACT
1 Limiting expenditure of public moneys on illegal aliens; and 2 providing for requests for reimbursement of public moneys 3 expended on illegal aliens.
4 The General Assembly of the Commonwealth of Pennsylvania 5 hereby enacts as follows: 6 Section 1. Short title. 7 This act shall be known and may be cited as the Protection of 8 Public Benefits Act. 9 Section 2. Limitation on public moneys. 10 (a) General rule.--No public moneys shall be expended on, 11 and no public benefit shall be provided to, any illegal alien 12 with the exception of expenditures for: 13 (1) emergency medical care; or 14 (2) law enforcement, prosecution, incarceration and
1 related expenses. 2 (b) Definition.--As used in this section, the term “illegal 3 alien” means a noncitizen of the United States who is within 4 this Commonwealth and who is in violation of Federal immigration 5 laws. 6 Section 3. Cooperation with Federal law enforcement. 7 Any Commonwealth law enforcement officer who releases an 8 illegal alien into the custody of the United States Department 9 of Homeland Security or other Federal law enforcement officials 10 shall prepare an invoice listing the cost of any arrest, 11 incarceration or detainment of the illegal alien. The law 12 enforcement officer shall transmit this invoice along with any 13 identifying information concerning the illegal alien to the 14 Department of Revenue of this Commonwealth. 15 Section 4. Request for reimbursement of public moneys. 16 The Department of Revenue shall, upon receipt of an invoice 17 under section 3, attempt to ascertain the total expenditures of 18 public money by the Commonwealth, any political subdivision or 19 any agency, authority, board or commission of the Commonwealth 20 or any political subdivision to benefit the illegal alien during 21 the period the illegal alien was within this Commonwealth and in 22 violation of Federal immigration laws. The total expenditures 23 shall be listed on a public benefits statement. The public 24 benefits statement shall be provided to the United States 25 Department of Homeland Security and the United States Department 26 of State for transmission to the country of origin of the 27 illegal alien with a request that such country reimburse the 28 Commonwealth for the expenses. Any funds received by the 29 Commonwealth shall be distributed pro rata to the Commonwealth, 30 any political subdivision or any agency, authority, board or
20060H2761B4220 - 2 - 1 commission of the Commonwealth or political subdivision that 2 expended public money to benefit the illegal alien. 3 Section 5. Effective date. 4 This act shall take effect in 60 days.
F5L67AJM/20060H2761B4220 - 3 -
|
|
To contact me--Robert B. Sklaroff, M.D.--just send an e-mail (rsklaroff@comcast.net).
|