FUNDAMENTALLY EQUAL!

 

It is a sign of our times: the situation of millions of men and women, the elderly, young people and children who, in today's world, feel forced or are compelled to leave their places of origin, their villages or nations, for many and varied reasons, including conflicts, violence, administrative corruption, unemployment, natural disasters, and political persecution. They leave to immigrate and take refuge in other places on earth in search of better living conditions. This sign of our times cries out to the heavens and becomes a disgrace for humanity because—in the vast majority of cases—the national governments in the countries of origin and destination of the migratory waves have not found or given dignified, humane, and definitive solutions to the serious humanitarian problem that the phenomenon represents. 

We would say that this is, if not the largest, one of the most significant and worst tragedies that humanity faces today in the many corners of this planet. The United States does not escape this phenomenon. On the contrary, this nation—throughout its history—has been one of the main points of attraction for large waves of immigrants.

From the first day of his Pontificate, Pope Francis has shown great human sensitivity, an enormous concern, and interest in the subject and the grave situation of the world's immigrants. Through a massive number of messages and interventions, he has taught us that to face and give a humane and adequate solution to the problem we must first resolve our fears and prejudices; our intolerances and inner walls; open ourselves in compassion and love to all; be capable of empathy for our fellow human beings; be capable of respect, justice, and mercy for all human beings, for those who are fundamentally equal to us in everything; be capable of not excluding and not discriminating against anyone and of putting the least among us first, of creating spaces of dignity for the "discarded" and those who suffer most in our societies; be capable of building the world as a great table and the earth as our home, the home of all.

For more than three decades in this nation, we have advocated for a radical and definitive solution to the issue of undocumented immigration, represented by the millions of men and women who, right now and for decades, have arrived in this country, seeking better living conditions for right now and in the future, for both themselves and their families, here and in their places of origin, contributing their work to the development and progress of this great nation.

But, without regulation and documentation allowing them to live and function as citizens with all their human and civil rights protected by law and the constitution, they are forced to live in the shadows, as in an underworld, a subculture, in which millions of men, women and entire families of undocumented immigrants live subjected to uncertainty, abuses, persecutions, discriminations, labor exploitation, social marginalization, lack of opportunities and free access to social benefits and all kinds of injustices and violence, etc.

Right now, and for decades, the United States has been an example of democracy, respect for the law, and human rights for the world. The inhumane, unequal and unjust situation in which millions of undocumented immigrants live in this country is hypocritical and contradicts the founding principles of this nation and the Constitution that governs us. Therefore, we must reach a humane, dignified, reasonable, concerted, integral, definitive, and prompt solution without further truces or delays. To continue without solving this important sociopolitical issue is to prolong an unsustainable and inhumane situation, postpone dignified living conditions for millions of people, and to continue the national shame that this situation means for this nation before the eyes of the world.

All the parties and governments that in past decades have led the life of this nation have spoken of immigration as a priority issue in the electoral, economic, cultural, political, and social spheres. But the solution has not come. It is not coming. This is indeed an issue of enormous complexity due to the many sides and dimensions it contains and implies. On the part of politicians, it has become a popular issue and one of opportunism and electoral convenience that must be kept active.

On the part of employers, legal solutions that would force them to fairly pay their employees more do not suit them. On the part of the American people, there are many fears and prejudices (superiority or inferiority complexes, racial and cultural biases, labor fears) that allow them to reject and discriminate instead of accepting and welcoming them. On the part of undocumented immigrants—because they forget what is important to solve what is urgent: providing an immediate solution to their economic needs—they abandon more critical struggles for their better long-term living conditions and turn their stay in the country into an economic advantage instead of an integration with the new nation that welcomes them. On the part of the rulers of the nations sending immigrants: a definitive solution in the United States for their immigrant populations solves their problems and alleviates their negligence and administrative corruption.

But it is precisely the complexity of this issue that challenges our greatness as a nation so that, above all, through frank, open dialogue and national consensus, we can find a humane, dignified, and comprehensive solution. A solution for everything and everyone. A solution that recognizes every human dimension of each undocumented immigrant (housing, education, employment, political, social, and cultural integration into American society, etc.), their families, and all immigrants coming from the most diverse nations present in this country.

The vast majority of undocumented immigrants are noble and good men and women, selfless workers, deserving of a better life, who crossed the border or stayed to live in this country for many years without the required documentation, men and women who pay taxes, but do not see their efforts and contributions to the nation's progress rewarded with laws and social benefits. Yet, they choose to endure the new abuses to which our country subjects them rather than return to the worse living conditions they left behind. And as in every society and human community, there is also an undeniably immense minority among them who add, to their undocumented status, the status of illegal aliens for infractions to the laws or crimes they commit.

The entire nation must pay real attention to this serious problem. We must legalize the situation of millions of undocumented immigrants in the United States. Any abuse, inequity, and injustice that continues to occur on our soil will remind us that we have not been capable, that we have not done well, and that our leaders, politicians, and rulers were not and are not up to addressing the circumstances and the demands of our life as a nation. We need more proposals and fewer protests.

We must work together to overcome—once and for all—this stain and shame on our existence as an American people. The United States cannot continue to be a nation with first-, fifth- and last-class inhabitants. All inhabitants of the United States, fundamentally equal, must live in equity and justice, with equal living conditions for all and equal access to the same benefits and social opportunities.

Mario J. Paredes is the CEO of SOMOS Community Care: a network of 2,500 independent physicians—mostly primary care physicians— who serve nearly one million of New York City's most vulnerable Medicaid patients.

A call to open our hearts to migrants and refugees

 

POPE FRANCIS HAS URGED WORLD LEADERS and the people they govern to open their hearts to the stranger already in their midst or seeking desperately to gain entry to their countries. In his message for the 107th World Day of Migrants and Refugees—to be observed Sept. 26, 2021—the Pontiff presents his vision of a world in which “all peoples are united in peace and harmony, celebrating the goodness of God and the wonders of creation.”

The Pope said that “we must make every effort to break down the walls that separate us and, in acknowledging our profound interconnection, build bridges that foster a culture of  encounter. Today’s migration movements offer an opportunity for us to overcome our fears and let ourselves be enriched by the diversity of each person’s gifts. Then, if we so desire, we

can transform borders into privileged places of encounter.”

To turn “our borders into privileged places of encounter”—what a powerful call to humanize US immigration policy and move it beyond the legalism that protects narrow political and economic interests at the expense of millions of suffering men, women, and children.  Granted, the Pope’s perspective on a complex reality sets the bar very high. Yet, something  must be done to begin to abet the massive suffering of those seeking access to the US to flee tyranny, violence, hunger, or poverty.

First and foremost, immigration reform that even modestly echoes the papal vision has to be a bipartisan effort. Today, the issue is a political football, with both parties opposing genuine, far-reaching reform efforts that would promise to deliver votes to the party pushing for such change. The Biden Administration is making some welcome changes to Trump-era policies, but it is stopping short of transforming the system. Real change would put the spotlight on and acknowledge the human drama that—here and around the world—impels refugees and migrants to take huge risks in seeking safety and prosperity. 

US immigration policy remains a patchwork, while a holistic vision is urgently called for. What is needed is a significant overhaul that promises to bring comfort to millions living in fear and darkness, and suffering abuse and mistreatment. 

Some painful truths must be openly discussed. One is the fact that racism is a key factor obstructing change. At both the leadership and grassroots level, there is sheer prejudice against people of color and different cultural backgrounds. Some of it finds expression—in the US and around the world—in what Pope Francis calls “myopic and aggressive forms of nationalism.” 

Then there is the persistent myth that immigrants, legal and otherwise, take jobs away from US citizens. The truth is that the work these newcomers do—cleaning, dishwashing, various forms of hard labor, etc., all underpaid—is looked down upon and rejected by Americans. That is true also for the work that brings migrant workers to this country, backbreaking work tilling the soil. Lacking alternatives, these workers overstay their visas and end up like  bonded laborers, lacking any legal standing. It should also be noted that most undocumented workers—so highly vulnerable to exploitation—pay taxes! 

According to official data, there are an estimated 10.5 million undocumented immigrants in the US, but the actual total may be significantly higher. There are also untold millions of young men who were born here of undocumented parents or who arrived when they were very young. Many have gone to college. But because of their parents’ immigration status, they lack the documents that would allow them to fully integrate into US society—they are at risk of being deported, sent ‘home’ to a country where they never lived or which they left as very

young children. 

Leaving aside the multitudes clamoring at our border for entry, these young men, like their parents, are begging to stay in the US. There is a clear injustice here. The US should offer  both generations a path to citizenship that does not take 10 or20 years. As it stands, the  country has condemned them to live in the shadows without any rights for many years. 

It behooves us as a nation founded on Judeo-Christian principles to promote policies that respect the human dignity of all those seeking shelter in the US. We need laws that acknowledge the common humanity that unites us all, regardless of skin color, socio-economic status, or legal standing. The earth, said Pope Francis, is our “common home.” 

The Pope has called for “a personal and collective commitment that cares for all our brothers and sisters who continue to suffer, even as we work towards more sustainable, balanced, and inclusive development. A commitment that makes no distinction between natives and foreigners, between residents and guests, since it is a matter of a treasure we hold in common, from whose care and benefits no one should be excluded.” 

Now, there is a vision for immigration reform. In the end, said the Pontiff, “we are like many grains of salt, all different and unique but which together can form a beautiful beach, a true work of art.”

Mario J. Paredes is CEO of SOMOS Community Care, a network of 2,500 independent physicians—most of them primary care providers—serving close to a million of New York  City’s most vulnerable Medicaid patients.

Value-Based Payment is the Future of Funded Health Care

 

A NEW APPROACH TO MEDICAID SPENDING is poised to transform health care for the poor across the US. The development has yet to make headlines, but the medical establishment is taking notice of federal and state medical authorities embracing Value-Based Payment (VBP) or Pay-for-Performance. 

It is a radically different formula to set the compensation model for physicians serving the most vulnerable patients: doctors earn more for their services when the people they serve have better longer-term health outcomes. Simply put, doctors are rewarded for taking better care of their patients—and there are savings for taxpayers as people are kept out of emergency rooms and costly hospital beds. 

VBP stands in sharp contrast with the traditional Medicaid compensation model, under which providers are paid per transaction—an office visit or a test, for example—medical services that rarely if ever add up to a holistic, preventative care package. Such superior care is precisely the promise of VBP-driven health care. The new formula considers all the patients’ needs, not just medical but also behavioral and social, and care on all these fronts is carefully coordinated. 

VBP-driven care also stands for a ready welcome of the patient, whereas traditional Medicaid confronts the patient with a forbidding labyrinthine system that is decidedly not user-friendly. While the traditional Medicaid compensation model is prone to waste and fraud, the efficacy and success of VBP-driven care are demonstrated by the careful and comprehensive maintenance of electronic medical records that substantiate evidence of patients’ longer-term wellbeing. 

The VBP formula puts primary care physicians (PCPs) in the driver’s seat. It is these community-based doctors who are on the frontlines of providing care to the most vulnerable members of society; they are most often these patients’ first point of contact with the health-care system. As such, signing on to the VBP compensation model, PCPs are in an ideal position to become a catalyst for better quality health care.

That has been the experience of SOMOS Community Care, a network of community-based 2,500 physicians, most of them PCPs, that is providing superior care to one million of New York City’s most vulnerable Hispanics, African Americans, and Asian Americans. SOMOS launched in 2014 as a so-called Performing Provider System mandated by New York State’s Delivery System Reform Incentive Payment (DSRIP) program with VBP at its core. The organization developed what it labels Neighborhood-Based Primary Care, reinventing, reiterating, and restoring the role of the PCP as a trusted and pivotal leader in the community. 

SOMOS doctors work closely with Community Health Workers (CHWs), who visit patients’ homes, where they see first-hand what social conditions—such as poverty, substandard unhygienic housing, and unemployment—may aggravate medical conditions. Such non-medical factors are known as Social Determinants of Health, and taking these into account is a crucial dimension of VBP-driven care. This rounds out the intimate, comprehensive picture PCPs have of their patients’ needs—and that knowledge is key to establishing a relationship of trust between patient and doctor. This personal dimension is a long way from the relatively impersonal nature of doctor-patient relationships characteristic of the traditional Medicaid system. For SOMOS doctors, the fact that many share the same cultural background as their patients further strengthens the patient-doctor bond. 

SOMOS practices qualify as so-called Patient-Centered Medical Homes, a one-stop point of entry to a full spectrum of care, with the PCP aware of and coordinating all forms of care given to the patient. The doctor and his staff are responsible for maintaining, as noted, accurate and comprehensive electronic medical records—records that show SOMOS and subsequently the New York State Department of Health how well patients are doing. Data also serve to show how superior care translates into savings for taxpayers. SOMOS has managed to save more than $330M in Medicaid funding by reducing emergency room visits and hospital admissions by more than 35 percent. 

It is hard to argue with the VBP-driven health care’s combination of quality care, increased income for doctors, and greater freedom for them in practicing medicine, plus savings in public spending. Yet, some significant players in the healthcare universe have been slow to adopt VBP models, among them hospitals and Health Maintenance Organizations. These prefer to strictly control physicians’ fees and want to steer clear of signing contracts with their doctors. SOMOS doctors—remaining independent business owners—are required to sign contracts committing them to operate according to VBP provisions and foregoing fee-for-service compensation.

Undoubtedly, Value-Based Payment is here to stay. Beyond Medicaid, the model is clearly applicable to Medicare as well. In addition, the notion of providing better care and thus reducing costs in the longer run—even as payments made to doctors would go up—would seem to make sense for commercial insurance as well. It would require, of course, a leap of faith and letting go of established profit models. In the end, all parties—patients, doctors, and be it private or public funders—can benefit. 

Mario J. Paredes is CEO of SOMOS Community Care, a network of 2,500 independent physicians—most of them primary care providers—serving close to a million of New York City’s most vulnerable Medicaid patients.