Pakistani Americans: Bordered without Doctors
By Murtaza Haider
Ryerson University, Toronto


Despite thousands of distinguished doctors of Pakistani origin practicing in the US, Pakistani Americans are among the most deprived of healthcare services. Almost one in four Pakistanis is uninsured and thus enjoys no or limited access to the American healthcare system.

The data from US Census Bureau reveals that 23 per cent of the 409,000 Pakistanis in the US were uninsured in 2009, making Pakistanis the most uninsured cohort of all Asians in the US. While the number of Pakistanis has doubled in the US between 2001 and 2010, their per capita incomes continue to trail behind Indians and other immigrants from Asian countries, which keep a large cohort of Pakistanis uninsured in the US.

Immigrants from Pakistan are not alone in the healthcare wasteland in the US. Also performing poorly in healthcare accessibility are immigrants from Bangladesh, Korea, and Cambodia. India-born immigrants fare much better, such that the percent of uninsured Indians in the US is half of that of Pakistanis.

A report by the Asian American Center for Advancing Justice explores the uneven landscape of success and deprivation amongst South Asians in the US. While the American establishment selectively cites Asians as a successful example of the American melting pot, the reality however is quite nuanced. Unlike the softwared immigrants from Bangalore, whose economic success in the US enjoys bipartisan acclaim, the plight of Bangladeshis or Hmongs in the US, who experience significantly more poverty than the rest, has largely been ignored.

Access to affordable healthcare has been a major policy hurdle for the United States where, unlike Canada, Australia, and most of Western Europe, universal healthcare does not exist. This implies that individuals have to purchase healthcare at market prices from vendors or purchase health insurance instead. The gainfully employed in the US do not share this concern since their employers insure them and their families. But for a sizeable low-income cohort of approximately 45-million Americans, who are uninsured, the healthcare costs can be financially crippling.

A brief visit to a hospital in the US for a few routine tests and an overnight stay can easily run into tens of thousands of dollars. Many, if not most, of the 45-million low-income uninsured Americans cannot afford even a single night’s stay in the hospital. Thus, the uninsured either forgo medical treatment or consult doctors only when it is absolutely necessary, which ultimately results in inferior health outcomes for the uninsured in America than the rest.

The free market enterprise in healthcare in the US has created a system whose costs can no longer be borne by the society. The wage bill of healthcare professionals, mostly doctors, and the profits demanded by the pharmaceuticals and HMOs have left 45-million without adequate healthcare in one of the most resource rich countries in the world.

Realizing the challenges faced by the uninsured Americans, President Barak Obama has remained determined to extend the healthcare coverage to the 45-million uninsured Americans. The Obama Health Care Reform promises affordable healthcare for all by regulating the healthcare marketplace.

One would have hoped to see universal support for universal healthcare in the US. What can be so wrong in extending the healthcare protection to 45-million uninsured in the US? The reality, however, is quite different in the US where the Obama Healthcare Reform has become a bone of contention between the Democrats (proponents) and the Republicans, who believe that the US government and businesses cannot afford to pay the healthcare costs of their fellow (low-income 45-million) citizens. The Republicans challenged the proposed healthcare reforms in the US Supreme Court, which decided in favor of President Obama’s plan and in the process diluted the plan as well. The equally split verdict between the Supreme Court judges (four judges voted to keep the plan while another four found the plan unconstitutional) needed Chief Justice John G. Roberts Jr.’s vote to break the tie. Fortunately for President Obama, the Chief Justice favored his plan.

While the Americans have continued to debate and agonize over the merits of their healthcare system, the fact remains that theirs is one of the most expensive healthcare system even amongst the developed economies. The US spends 18 per cent of its GDP on health, which is 50 per cent more than Germany. Canadians also enjoy universal healthcare and spend only 11 per cent of their GDP on health.

I have used the healthcare system in France and Greece during vacations and was amazed to see the low healthcare costs I paid even as an uninsured consumer. The doctors’ fees were nominal in Paris and Athens and the medicine cost a fraction of what it used to cost in New York.

A large number of Pakistanis are also included in the 45-million uninsured in the US. It is rather odd to see the 10,000-plus Pakistan-born influential and vocal physicians in the US on one side and on the other the 100,000 Pakistanis with no access to healthcare who are ultimately left at the mercy of charities.

While the Pakistan-born physicians in the US continue to play a role in lobbying the US government on its foreign policy, they may also want to consider expanding their efforts to extend healthcare to thousands of uninsured Pakistanis in the US who have been bordered without doctors.

(Murtaza Haider, PhD is the Associate Dean of research and graduate programs at the Ted Rogers School of Management at Ryerson University in Toronto. Courtesy Dawn)


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