For the next month, Congress will undertake the daunting feat of trying to solve the nation’s health care woes.

Given the complexity, real change, if any, is likely to be more incremental than substantive, say UC Davis faculty members. The crux of the issue is who gets health care coverage and who has to pay for it.

Economic historian Peter Lindert says the “angel and devil are both in the details.” A unified and competitive health care plan can work extremely well, he believes, but only if policymakers get the details right. With skyrocketing cost, one might think the urgency is clear — but this actually makes a deal more difficult.

“Rising costs have indeed posed such an obstacle for 40 years now,” said Lindert, whose 2004 book, Growing Public: Social Spending and Economic Growth Since the Eighteenth Century, spells out the impacts of big social safety nets on the world's richest democracies.

Case in point: Four years ago, all of the Big Three auto firms were shifting their production jobs to Canada to cut health insurance costs and be able to price their cards more competitively, he noted. In other words, not solving the health care crisis would be bad for American business and workers.

But can the federal government actually come up with the solution? 

“It can do all of these things if done right. Europe and Canada have government-led health care and insurance. But some elements of market competition should be preserved,” Lindert said.

Undocumented immigrants

As for whether undocumented immigrants should receive health care coverage, Lindert maintains that health care for them is but a small share of the budget.

“We should not make up our minds about the huge issue of everybody health care on the basis of stories about what happens to the small non-citizen share of potential patients. The cost of health care for non-citizen residents in any case already falls partly on the U.S. taxpayers — through expensive emergency care if not through insurance."

He recalls that when his family was living in Great Britain, they received hefty health care benefits as non-citizens when his son was hurt in an accident and required surgery.

“We paid zero. We didn’t go to Britain to have an accident, but a civilized society does provide emergency care for visitors.”

Kevin Johnson, dean of the UC Davis law school, says one problem is that many Americans believe that undocumented immigrants “over consume” scarce health care resources. The data does not justify this claim, he said.

He also disputes the perception that Mexicans illegally enter into America in search of health care benefits. No credible evidence exists for this view either, he said.

“The social science literature is that almost all undocumented immigrants come to the U.S. in search of jobs and economic opportunity,” Johnson said. “In fact, undocumented immigrants are denied access to the most common federal benefit programs.”

But is health care for undocumented immigrants a drag on the U.S. economy?

Johnson: “This is a complex question. Undocumented immigrants generally only have access to free emergency medical treatments. This can be costly for state and local governments. But it is outweighed by the federal, state and local taxes paid by undocumented immigrants.”

He said that many such immigrants have filed federal tax returns, yet are not eligible for tax benefits, like the earned income tax, that other taxpayers enjoy.

Down to the human level, Johnson said Hispanic women and children suffer the most in a society without universal health care coverage.

“In many instances they are the primary child care provider,” he said. “They are affected by the lack of health coverage for them as well as their child, for which in some cases they might have to miss work.”

The next step: To meet President's Obama request to have a health care bill on his desk in October, Congressional leaders hope that the Senate and House can pass its version of the bill before the August summer recess.