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1AC..............................................................................................................................................................................20 1AC..............................................................................................................................................................................21 1AC..............................................................................................................................................................................22 1AC..............................................................................................................................................................................22 1AC..............................................................................................................................................................................24 Inherency.....................................................................................................................................................................25 Poor Immigrants lack HC............................................................................................................................................28 No HCImmigrants Get Sick....................................................................................................................................29 Status Quo=Deportation..............................................................................................................................................30 More Immigrants Uninsured.......................................................................................................................................31 AT: T PLIPs- Those Uninsured are poor....................................................................................................................32 Solvency.......................................................................................................................................................................33 Solvency.......................................................................................................................................................................35 Solvency.......................................................................................................................................................................36 Bioterrorism.................................................................................................................................................................37 Bioterrorism.................................................................................................................................................................38 Bioterrorism.................................................................................................................................................................39 Bioterrorism.................................................................................................................................................................45 Bioterror Outweighs....................................................................................................................................................46 Congress Action Key to Bioterror..............................................................................................................................47 Disease Adv. ...............................................................................................................................................................48 TBXTN....................................................................................................................................................................56 TB growing..................................................................................................................................................................57 TB growing..................................................................................................................................................................58 Immigrants Swine Flu.............................................................................................................................................59 Moral Obligation.........................................................................................................................................................65 Security 1AC...............................................................................................................................................................66 Squo=Racism...............................................................................................................................................................80 .....................................................................................................................................................................................81 Immigrants Help Econ-Housing Market.....................................................................................................................81 2AC- Plan Helps Econ.................................................................................................................................................82

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2AC- Econ Add-On.....................................................................................................................................................83 Econ/Hospitals Extension............................................................................................................................................88 Rubenstein cites a recent construction boom among the nation's hospitals. As many as 60 percent of America's hospitals are either under construction or have plans for new facilities. "But we have a two-tier hospital system in the U.S. Hospitals in poor areas that serve primarily uninsured immigrants and Medicaid patients cannot afford their facilities," he writes. "The uncompensated costs are killing them. In California, 60 emergency departments (EDs) have closed to avoid the uncompensated costs of their largely illegal alien caseloads." Illegal aliens use emergency rooms more than twice as often as U.S. citizens, and providing their uncompensated care has been the death of many emergency departments. In 2006, more than 46 percent of illegals did not have medical insurance. Although illegal aliens are not supposed to be eligible for Medicaid, they receive Emergency Medicaid and their children are entitled to all benefits that legal immigrants receive. Because hospitals are forced to care for Medicaid recipients, the government program never covers full costs of service. It underpaid hospitals by $11.3 billion in 2006, he wrote..............................................................................................................................88 Human Rights/ Heg Advantage...................................................................................................................................89 Human Rights/ Heg Advantage...................................................................................................................................90 Plan Reduce Federal Spending....................................................................................................................................91 Plan Reduces Federal Spending..................................................................................................................................92 Human Rights/ Heg Advantage...................................................................................................................................93 Human Rights/ Heg Advantage...................................................................................................................................94 Human Rights/ Heg Advantage...................................................................................................................................95 Human Rights/ Heg Advantage...................................................................................................................................96 RMA Add-on...............................................................................................................................................................98 RMA Add-on...............................................................................................................................................................99 Ext. Mexican Collapse...............................................................................................................................................100 Mexican Collapse Heg Collapse...........................................................................................................................101 Soft Power Solves All..............................................................................................................................................103 Soft Power Key to Terrorism....................................................................................................................................103 Soft Power: Warming/Disease/Environment............................................................................................................105 2AC States CP...........................................................................................................................................................106 ATExtra T (PLIPs)................................................................................................................................................108 ATExtra T (Social services)..................................................................................................................................109 ATSubsets T..........................................................................................................................................................110 ATT: PLIPs............................................................................................................................................................111 ATT: Citizens only................................................................................................................................................112 ATImmigration DA...............................................................................................................................................113 ATUniversal health care CP..................................................................................................................................116 2AC: Fiscal D............................................................................................................................................................119 2AC: Fiscal D............................................................................................................................................................120 2AC: Fiscal D............................................................................................................................................................121 Politics: Plan Bipart...................................................................................................................................................123 Plan Popular-Lobbies................................................................................................................................................124 2AC: Military DA......................................................................................................................................................125 Ext. Military DA- Inevitable.....................................................................................................................................127 DA N/U: Social Service/Medicaid Increasing..........................................................................................................128 Cap K 2AC (1/6).....................................................................................................................................................129 Cap K 2AC (2/6).....................................................................................................................................................130

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Cap K 2AC (3/6).....................................................................................................................................................131 Cap K 2AC (4/6).....................................................................................................................................................132 Cap K 2AC (5/6).....................................................................................................................................................133 Cap K 2AC (6/6).....................................................................................................................................................134 Legalize Drugs 2AC (1/5)......................................................................................................................................135 Legalize Drugs 2AC (2/5)......................................................................................................................................137 Legalize Drugs 2AC (3/5)......................................................................................................................................138 Legalize Drugs 2AC (4/5)......................................................................................................................................139 Heg Bad 2AC (1/4).................................................................................................................................................140 Heg Bad 2AC (2/4).................................................................................................................................................141 Heg Bad 2AC (3/4).................................................................................................................................................142 Heg Bad 2AC (4/4).................................................................................................................................................143

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Observation one is inherency: Fear of deportation deters immigrants from accessing preventive healthcare Ku and Matani, Senior fellows at the Center of Budget and Policies, 08
(Leighton Ku and Sheetlal Matani, senior fellow at the Center on Budget and Policy Priorities, in Washington, D.C. AND Washington Free Clinic worker, 2008 http://content.healthaffairs.org/cgi/content/full/20/1/247? maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=ku&andorexactfulltext=and&searchid=1&resourcetype=hwcit) Public attention has recently focused on racial and ethnic disparities in access to health care, and research indicates that Latinos have the highest uninsurance rates among racial/ethnic groups living in the United States.1 But there has been surprisingly little discussion of the importance of immigration status, although one-third of U.S. Hispanics and two-thirds of U.S. Asians are foreign-born. Immigrants are a large and growing segment of American society and are

disproportionately low-income and uninsured.2 Thus, the status of immigrants has broader implications for national and state efforts to improve access to health care. The 1996 federal welfare reform law (Personal Responsibility and Work Opportunity Reconciliation Act, or PRWORA) restricted Medicaid eligibility of immigrants, so that those admitted to the United States after August 1996 cannot receive coverage, except for emergencies, in their first five years in the country.3 Historically, legally admitted immigrants were eligible for Medicaid and other benefits on the same terms as citizens were, but PRWORA signaled an important change in the social contract. These policies exacerbated immigrants fears that began after the enactment of Californias Proposition 187 and after publicity about the Immigration and Naturalization Service (INS) efforts to apply "public charge" enforcement to Medicaid, asking immigrants to repay the value of Medicaid benefits received or else jeopardize their U.S. residency status. 4 Collectively, these policies signaled that legal immigrants should avoid Medicaid, even if they were uninsured and eligible.

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Hence the plan: The United States Congress should Repeal Section 434 of the Personal Responsibility and Work Opportunity Act and Section 642 of the Immigration Reform Law.

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Advantage one is bioterror: A Bioterror attack is coming soon Katel, Time Journalist, 09
(Peter, former TIME journalist, frmr writer for World Bank, won the Interamerican Press Associations Bartolome Mitre Award, Homeland Security: Is America safe from terrorism today? CQ Researcher, 2/13/09, http://library.cqpress.com/cqresearcher/document.php?id=cqresrre2009021300) Independently, a congressional panel announced in late 2008 that trouble looms. Unless the world community acts decisively and with great urgency. It is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013 , said the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. The Commission further believes that terrorists are more likely to be able to obtain and use a biological weapon than a nuclear weapon. While the commisison conceded that highly specialized knowledge and equipment would be indispensable to mount a bio attack, it noted that trained biologists are relatively numerous. Terrorists are trying to upgrade their capabilities and could do so by recruiting skilled scientists, the commission said. Meanwhile, the Government Accountability Office (GAO) reported in late 2008 that security is sub-par at two of the five U.S. laboratories authorized to handle deadly pathogens, the WMD commission said. The two insecure facilities were at Georgia State University in Atlanta and the Southwest Foundation for Biomedical Research in San Antonio, Texas.

Lack of healthcare for immigrants is the single biggest obstacle to controlling a bioterror attack Wynia and Gostin, Masters of public health and prof of law, 02
(Matthew K. Wynia is a Master of Public Health at the University of Chicago, Lawrence Gostin received his J.D. at Duke University and is currently the professor of law and public health at Johns Hopkins University, The Bioterrorist Threat and Access to Health Care, May 31st 2002, http://www.sciencemag.org/cgi/content/summary/296/5573/1613, [Abhik])

The intentional dispersal of anthrax spores in the United States demonstrates the need for preparedness for bioterrorism and naturally occurring infectious diseases capable of causing mass civilian casualties. In the event of a bioterror attack, medical-care professionals and institutions will be called on to help in the
rapid identification of health threats, to help prevent the spread of disease in the population, and to care for and treat infected patients. Many barriers to accomplishing these tasks, like improved training of health-care practitioners, funding for facilities improvements and pharmaceutical stockpiles, and coordination of information and reporting systems, are being explored and addressed (1). However, one additional issue might prove to be among the most formidable barriers to the effective handling of a bioterror attack in America. Recognizing the importance of early detection, the U.S. government has devoted considerable attention to expanding the national public health system's capacity to detect outbreaks (1). These detection systems rely largely on reports from the medical-care system; after all, persons with symptoms will likely present first in physicians' offices, clinics, or hospital emergency departments. But consider this: what if the first individual infected with a transmissible illness chooses not to be evaluated within the medical-care system? Such an individual's

illness, left undetected, might spread to family, neighbors, and other contacts. If these secondarily infected individuals also face barriers to care, the illness will spread further. In this way, a large-scale outbreak could be well under way before the medical community has an opportunity to make the first diagnosis. Once an outbreak occurs on a large scale, today's travel and work patterns could lead very rapidly to nationwide, or worldwide, dissemination. There are many potential reasons why an infected patient might
not present for evaluation by the medical-care system. Some, like individual stoicism and bravado in the face of illness, are less amenable to intervention by the medical-care system. However, more than 40 million U.S. citizens have no health insurance, a problem not faced by any other advanced industrialized nation. Their lack of insurance is a known risk to their

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own health (2), but it must now also be recognized as a risk to the nation's health (3). The Federal Welfare Reform Act of 1996 exacerbated the problem by virtually prohibiting federally funded medical clinics from providing most services to illegal immigrants (4). Publicity surrounding this law and its enforcement has been most damaging. For instance, although the act has specific exceptions for emergency treatment and for testing and treatment of symptoms of communicable diseases, Texas's state attorney general, John Cornyn, issued an opinion on 10 July 2001 stating that the Act precluded public clinics and hospitals in Texas from providing most services to illegal immigrants. An argument by Texas's public hospitals that early entry into the health-care system is cost-effective and necessary to protect the public's health did not sway the state from pursuing a strict interpretation of the Act. Indeed, before September 11, a lawsuit against the hospitals was being considered [(5), the suit is now "in limbo" (6)]. Adding to these concerns may be immigrants' and health-care professionals' memories of California's Proposition 187, which called on practitioners to refuse to treat illegal immigrants and to report them to immigration authorities (7). Passed in 1994, this proposition was never fully implemented and its health-care provisions were turned back in 1999 during mediation by the Settlement Program of the 9th Circuit Court of Appeals, but it has undoubtedly contributed to mistrust of the medical-care system among immigrants (8). In the aftermath of the attacks on the World Trade Center buildings, attempts have been made locally to remove barriers to access. The Governor of New York issued Executive Orders 113 and 54, declaring a state disaster and, in the words of New York's Health Commissioner Antonio Novello, ordering medical-care providers, "Thou shalt not ask who will pay for this" before providing care for potential victims of the attacks (9). Over the next 4 months, New York's Disaster Relief Medicaid program enrolled almost 400,000 people (10). Doing so involved obtaining additional funding from the state pool for the uninsured and a dramatic streamlining of the application process for Medicaid (9). In our view, a similar lowering of barriers to access is in order for everyone living within U.S. borders. In particular, two steps should be taken immediately to facilitate detection and reporting of infectious diseases. First, a homeland defense directive should go out, stating that individuals with symptoms that suggest infection with a contagious illness should present for evaluation and that those who do so will be treated without prejudice. Second, patients and physicians should be assured that no adverse consequences will result from reports to public health departments. An

effective national defense against bioterrorism requires that all potentially infected patients can be at least evaluated without fear of deportation or other significant social or economic losses. Although additional funds will be required to evaluate uninsured patients, the investment in detection is the right thing to do--and it might even save money in the long run, as treatable and preventable illnesses are detected earlier and contained.

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If not controlled this attack will end in extinction outweighs nuclear war Steinbruner, Director of CISSM, 97
(John D. Stienbruner, Professor of Public Policy at the School of Public Policy at the University of Maryland and Director of the Center for International and Security Studies at Maryland For. Pol. No, 109, Winter 1997-1998)

Although human pathogens are often lumped with nuclear explosives and lethal chemicals as potential weapons of mass destruction, there is an obvious, fundamentally important difference: Pathogens are alive, weapons are not. Nuclear and chemical weapons do not reproduce themselves and do not independently engage in adaptive behavior; pathogens do both of these things. That deceptively simple observation
has immense implications. The use of a manufactured weapon is a singular event. Most of the damage occurs immediately. The after effects, whatever they may be, decay rapidly over time and distance in a reasonably predictable manner. Even

before a nuclear warhead is detonated, for instance, it is possible to estimate the extent of the subsequent damage and the likely level of radioactive fallout. Such predictability is an essential component for tactical military planning. The use of a pathogen, by contrast, is an extended process whose scope and timing cannot be precisely controlled. For most potential biological agents, the predominant drawback is that they would not act swiftly or decisively enough to be an effective weapon. But for a few pathogensones most likely to have a decisive effect and therefore the ones most likely to be contemplated for deliberately hostile usethe risk runs in the other direction. A lethal pathogen that could efficiently spread from one victim to another would be capable of initiating an intensifying cascade of disease that might ultimately threaten the entire world population. The 1918 influenza epidemic demonstrated the potential for a global contagion of this sort but not necessarily its outer limit. Giving health care to immigrants is critical to minimizing the impact to a bioterrorist attack Donohoe, MD @ Portland, 07
(Martin Donohoe, MD @ Portland State University, 2007, http://www.springerlink.com/content/v2r74824uv349208/fulltext.pdf?page=1) Lees otherwise comprehensive review of the role of Internists during epidemics, outbreaks, and bioterror attacks1 neglects to mention their role in preventing such events. Internists can minimize the effects of epidemics and outbreaks by vaccinating their patients according to Centers for Disease Control and Prevention (CDC) recommendations, especially those who are immunosuppressed. Educating all staff members regarding universal precautions and how to respond to potential events should improve response while decreasing unwarranted fears. Activism for universal health care coverage (including access to a primary care provider), which would decrease the burden on emergency departments during events. Such coverage should include undocumented immigrants, who could represent a reservoir of infection and whose reluctance to visit providers could result in delays in identifying outbreaks. Laws that require health care providers and clinics to check the citizenship of patients should be vigorously opposed, and undocumented immigrants assured that their status will not be reported to governmental authorities, except in the unlikely event that the patient is suspected of being involved in a terrorist plot.

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Advantage Two is International Human Rights Leadership: Denying immigrants access to Healthcare destroys U.S. human rights leadership Marietta, Graduate Student, 06
(Melissa Marietta, International Social Science Review, 2006, Undocumented Immigrants Should Receive Services,http://www.britannica.com/bps/additionalcontent/18/21409437/UNDOCUMENTED-IMMIGRANTS-SHOULDRECEIVE-SOCIAL-SERVICES [Abhik]) Social

For most Americans, immigration is a volatile and emotional issue. Opinions, rhetoric, and statistics concerning the impact of immigration on the U.S. economy are often hotly debated. One aspect of this debate that is largely ignored is the cultural impact of immigration on American society. Every ethnic group and nationality brings a new perspective, a different behavior, and traditions, all things that one cherishes. In seeking their piece of the American dream, immigrants bring richness and diversity to American culture. They thus improve the quality of life in America. Unfortunately, people cannot make policy on such ideals; instead, they focus on statistics and disregard the culture that enriches their lives. Undocumented immigrants are a growing percentage of the U.S. population, numbering nearly eleven million nationwide. [1] As their numbers grow, so too does the debate as to whether or not they should receive social service benefits provided to American citizens. Some Americans argue that undocumented immigrants should be denied all such services because they do not pay federal taxes; they are "illegal" citizens and a drain on government services and the economy. Denying public services to undocumented immigrants, they claim, will discourage them from entering the country. Such reasoning will not stop unauthorized immigration to the United States. Most immigrants come to the U.S. for better work opportunities and higher wages, not services. According to U.S. Representative Luis Gutierrez (D-IL): Undocumented workers will continue to enter America as long as there are jobs and employers willing to hire them. Congress and state legislatures are hesitant to enact laws which will affect employers adversely. They do not want to upset the business community which understands America's need for these workers and their contribution to the nation's economy. It is therefore hypocritical for U.S. immigration policy to welcome these immigrants to fill labor needs and then refuse to offer them any social services. If undocumented immigrants are denied social services, the quality of health, education, and safety of entire communities will suffer. Providing access to basic services may prevent problems from expanding into something communities cannot ignore and eventually cost more to remedy in the future. Services currently offered to undocumented immigrants include medical care, education, and benefits such as food stamps. Undocumented workers may also qualify for workers' compensation and veterans' benefits. By denying these services

to undocumented immigrants, the United States will simply create another subclass of people in its society. Many of the bills under consideration by various state legislatures seek to deny emergency medical treatment and education to undocumented workers. This violates the Emergency Medical Treatment and Labor Act (1986) which states that any patient cannot be denied emergency medical care based on his/her ability to pay. In addition, the U.S. Supreme Court, in Plyler v Doe (1982), ruled that public
education (K-12) must be provided to all children.[3] With two new U.S. Supreme Court justices, John Roberts and Samuel Alito, many anti-immigrant groups are hoping that this law and court decision will be reversed, but Americans must understand that these services create an educated and healthy populous necessary for the country to prosper. Education is an important social service available to everyone who resides in the United States because the government regards it as the most important credential one can bring to the labor market. The current national shortage of teachers and nurses can be partially remedied by immigrants. Yet, legislation is pending in some states to limit education opportunities for undocumented immigrants and their children. For example, the Georgia General Assembly, during its 2006 legislative session, considered several bills to that effect, including Senate Bill 171 that would require proof of American citizenship to attend state colleges and universities. Another proposal. House Resolution 256, seeks to amend the state Constitution in order to ban all undocumented children from public schools.[4] Bills denying educational opportunity will likely result in an increase in crime and poverty. Many immigrants do not receive needed Healthcare because they fear

deportation. Denying healthcare to any segment of the population can lead to more extreme ailments that become more expensive to treat. Dr. Hogai Nassery, a hysician who practices in Chamblee, GA, states: Reality dictates that millions of undocumented immigrants plan to remain in the United States. Denying them healthcare services will lead to increased instances of infectious, yet treatable diseases. The state legislatures of Georgia
and Oklahoma nonetheless are trying to bar undocumented immigrants from receiving any medical care, including

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emergency room services.[6] This overlooks the fact that most undocumented immigrants in the U.S. are younger workers. Since younger people tend to use less Healthcare than the elderly, healthcare cost estimates for undocumented aliens tend to be exaggerated.[7] The denial of healthcare is not only bad policy, it is unrealistic, cruel, and violates medical ethics. Should an undocumented worker involved in an accident be denied healthcare and left in front of a hospital to die?

Most physicians have ignored the laws and treated patients regardless of their immigration status. America has the moral obligation to care for those who reside here. Americans pride themselves on providing a moral compass for the rest of the world. They believe that every human life is precious and important. Denying any individual healthcare based on citizenship contradicts that belief. In championing the cause of human rights around the world, the United Nations strives to promote equality, freedom, "social progress [,] and better standards of life."[8] As the world's only superpower, the U.S. should be leading by example instead of debating whether or not undocumented immigrants deserve healthcare, education, and other benefits. The United Nations' International Convention on Economic, Social, and Cultural Rights (UNIESCR) is committed to "the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would assure to all, medical services and medical attention in the event of sickness." [9] UNICESCR also supports free education for primary school students and the availability of secondary and higher education for everyone. As one of the nations that signed this agreement, the United States should devote itself to the well being of all who reside within its borders.[10] Undocumented immigrants receive services other than simply healthcare and education. They drive on
roads, use public libraries, and use police and fire protection, to name a few. If one tries to deny public services to undocumented immigrants, where does one draw that line? When does one cross the line between enforcing laws that seek to protect and those that discriminate? If a person looks like an immigrant, must their identification be checked before admitting him/her to the hospital? Representative Gutierrez laments: anti-immigrant legislation makes any person who doesn't look "American" an immediate suspect, whether that person is applying for a student loan or Social Security benefits. Almost all of these proposals would turn every local agency, from schools to employment offices, into regulated outposts of the Immigration and Naturalization Service, forcing them to constantly check every applicant's immigration status. (11)

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Specifically, Domestic and Domestic human rights promotion is critical to international HR leadership Powell, Associate Law Prof., 08
(Catherine, American Constitutional Society, October) http://www.acslaw.org/files/C%20Powell%20Blueprint.pdf [Abhik])

a new Administration takes office in January 2009, it will have an opportunity to reaffirm and strengthen the longstanding commitment of the United States to human rights at home and abroad. This commitment is one that has been expressed throughout U.S. history, by leaders from both parties. In reality, however, when the idea of human rights is discussed in the United States today, more often than not the focus is on the promotion of human rights abroad and not at home. Indeed, human rights has come to be seen as a purely international concern, even though it is fundamentally the responsibility of each nation to guarantee basic rights for its own people, as a matter of domestic policy. Reaffirming and implementing the U.S. commitment to human rights at home is critical for two reasons. First, human rights principles are at the core of Americas founding values, and Americans (as well as others within our borders or in U.S. custody), no less than others around the world, are entitled to the full benefit of these basic guarantees. That can hardly be open to debate. The second reason is perhaps less obvious, but equally compelling. When the United States fails to practice at home what it preaches to others, it loses credibility and undermines its ability to play an effective leadership role in the world. Leading through the power of our example rather than through the example of our power3 is particularly critical now, at a juncture when the United States needs to cultivate international cooperation to address pressing issues such as the current economic downturn that have global dimensions. Perhaps not surprisingly, then, an overwhelming majority of Americans strongly embrace the notion of human rights: that is, the idea that every person has basic rights regardless of whether or not the government recognizes those rights.4Continues Even so, there remains a gap between the human rights ideals that the United States professes and its actual domestic practice, resulting in both a gap in credibility and a weakening of U.S. moral authority to lead by example. Human rights include the right to be free from
As torture or cruel, inhuman or degrading treatment, and yet the United States has committed such acts in the name of counterterrorism efforts. Human rights include the rights to emergency shelter, food, and water, as well as security of person, and yet the United States failed to adequately guarantee these rights in the aftermath of Hurricane Katrina. Human rights include the right to equality of opportunity, and yet inequalities persist in access to housing, education, jobs, and health care. Human rights include the right to equality in the application of law enforcement measures, and yet there are gross racial disparities in the application of the death penalty, and racial and ethnic profiling has been used unfairly to target African Americans, Latinos, and those who appear Arab, Muslim, South Asian, or immigrant (whether through traffic stops, airport screening, or immigration raids). Human rights include the right to equal pay and gender equality, and yet a pay gap persists between female and male workers. Certainly, the journey to fully realizing human rights is a work-in-progress, but to make progress, we must work through smart, principled policies that advance the ability of the United States to live up to its own highest ideals. Thus, January 2009 should mark the beginning of a transition from a society that has condoned torture, cruel interrogation, and inhumane treatment of detained terrorism suspects to a society that deems such conduct unacceptable not only by other nations, but by our own . We should

make the transition from a society that has tolerated little or no access to health care for certain individuals to a society that recognizes access to health care for all as a basic right. We should make the
transition from a society of structural inequality to one in which not only the very highest glass ceilings are broken, but also in which sticky floors and broken ladders to opportunity are repaired. Marking the transition in this way is both principled and in

Americas self-interest.

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Scenario One is Soft power: Giving immigrants access healthcare is key to restoring U.S. Soft Power and attracting educated immigrants to the U.S. Schulz, Senior Fellow at the Center for American Progress, 09
(William F. Schultz, to Adjunct Professor of International Relations at The New School, June 2009, The Power of Justice, Center for American Progress, http://www.americanprogress.org/issues/2009/06/pdf/humanrights.pdf [Abhik])

Nye, the renowned coiner of the phrase soft power, has described how an open attitude toward immigration can enhance Americas strategic interests: The fact that people want to come to the U nited States enhances our appeal America is a magnet, and many people can envision themselves as Americans. Many successful Americans look like people in other countries. Moreover, connections between immigrants and their families and friends back home help to convey accurate and positive information about the United States. In addition, the presence of multiple cultures creates avenues of connection with other countries and helps create a necessary broadening of American attitudes in an era of globalization it would be a mistake for Americans to reject immigration. Rather than diluting our hard and soft power, it enhances both.34 Conversely, every time an immigrant is treated shabbilywhen, for example, immigrant
Joseph children or asylum seekers are incarcerated in punitive conditions or when immigrants in detention are manhandled, held with the general prison population, or denied adequate medical carethe stories of their suffering work their way back to their native lands and diminish the United States in the populations eyes.35 Moreover, as Nye, Thomas Friedman, Leslie Gelb, and many other respected foreign policy analysts have repeatedly pointed out, to stay competitive in a globalized world the United States must rectify shortcomings in its educational system, the exorbitant cost of its health care, and the failure to provide what Friedman has called lifetime employability, which he characterizes not as the guarantee of a lifetime job but the chance to make [oneself] more employable.36This means that addressing social and economic rights to close the achievement gap between well-off children and othersa gap that is above the average for the Organization for Economic Cooperation and Developments 29 industrialized nations is not just a nice idea. It is a matter of national security, as is the need to make health care more affordable or job retraining more accessible in order for dollars and productivity not to be wasted.37 Among other things, failure to improve such conditions makes it harder to find healthy,

educationally qualified recruits for an all-volunteer army that often draws from the lower economic strata of the society. It also leaves the United States vulnerable to international economic pressures as President
Obama has discovered when he has tried to convince European nationswhich have far stronger safety nets than the United Statesto join in stimulus spending to end the recession.38 In all these ways and more international human

rights standards point the way to a safer, stronger America that is more respected and more economically resilientto say nothing of more just. As President-elect Obama put it in his Human Rights Day statement on December 10, 2008, standing up for human rights strengthen[s] our security and well-being, because the abuse of human rights can feed many of the global dangers that we confront.39 But if that is the case, then
why have Americans and their leaders been at best indifferent and at times downright hostile to the application of international standards to our domestic practices?

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Soft Power is key to solving every major impact including environmental collapse and prolif Stanley, Member of the National Security Advisement Board, 07
(Elizabeth Stanley, PhD in Government From Harvard University, Assistant Professor at George Town University, Member of the National Security Advisement Board of Sandia National Laboratories, International perceptions of U.S. Nuclear Policy http://www.prod.sandia.gov/cgibin/techlib/access-control.pl/2007/070903.pdf)

Such reputation effects can have significant impact in terms of gaining international cooperation in addressing global issues that require multilateral solutions and given the interdependent nature of the world today, most issues fall into this category. In contrast to a states hard power (military and economic might), soft power (a states culture, values and institutions) provides an indirect way to influence others. Soft power is an invaluable asset to: (1) keep potential adversaries from gaining international support and winning moderates over to
their causes; (2) influence neutral and developing states to support US leadership; and, (3) convince allies to support and share the international security burden. The United States needs soft power assets (including the moral high ground) to solve these problems multilaterally and proactively. For example, one of the wicked problems (problems having complex, adaptive, unpredictable components) that US nuclear policy and posture is trying to address is global proliferation of WMD. Yet, WMD proliferation is not a problem that the United States can address effectively alone. To address global proliferation concerns, the United States needs the rest of the world to participate

in the process. Given how complex the WMD proliferation problem is, this requires not only other international actors to commit to solving the problem with us but that they have a similar understanding of what the problem is. This common problem definition is not possible when the rest of the world has negative perceptions of the United States, when US policies and actions (in the nuclear and non-nuclear
arenas) are perceived as unilateral and hypocritical. Indeed, this paper suggests that many international actors appear to view US policy and actions as one of the contributors to the WMD proliferation problem. In other words, US actions actually affect how other states define the problem, and how they define the problem affects what they believe the right solution is. Given their different understanding, it is not surprising that the wicked problem becomes even thornier to address. In short, how other international actors perceive US policies and actions matters a great deal in their decisions about how much they will cooperate on the US policy goal of non-proliferation. (continued) How important is soft power, anyway? Given its vast conventional military power, does the United States even need soft power? Some analysts argue

that US military predominance is both possible and desirable over the long term, and thus soft power is not important. But a growing consensus disagrees. These analysts argue that soft power is critical for four reasons. First, soft power is invaluable for keeping potential adversaries from gaining international support, for winning the peace in Afghanistan and Iraq, and for convincing moderates to refrain from supporting extremist terrorist groups. Second, soft power helps influence neutral and developing states to support US global leadership. Third, soft power is also important for convincing allies and partners to share the international security burden.14 Finally, and perhaps most importantly, given the increasing interdependence and globalization of the world system, soft power is critical for addressing most security threats the United States faces today. Most global security threats are impossible to be countered by a single state alone. Terrorism, weapons of mass destruction (WMD) proliferation, failed and failing states, conflicts over access to resources, are not confined to any one state. In addition, disease , demographic shifts, environmental degradation and global warming will have negative security implications as well.15 All of these potential threats share four traits: (1) they are best addressed proactively, rather than after they develop into full-blown crises; (2) they require multi-lateral approaches, often under the umbrella of an international institution; (3) they are not candidates for a quick fix, but rather require multi-year, or multi-decade solutions; and, (4) they are wicked problems. Given these four traits, soft power is critical for helping to secure the international, multi-lateral cooperation that will be necessary to address such threats effectively.

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Environmental collapse causes extinction Diner, Vice chief of Staff, 94
The Judge Advocate General, Vice Chief of Staff, United States Department of the Army Personnel, Plans and Training Office Chief, the -1994 , Colonel David N., United States Army Military Law Review Winter, p. lexis) By causing widespread extinctions, humans have artificially simplified many ecosystems. As biologic simplicity increases, so does the risk of ecosystem failure. The spreading Sahara Desert in Africa, and the dustbowl conditions of the 1930s in the United States are relatively mild examples of what might be expected if this trend continues. Theoretically, each new animal or plant extinction, with all its dimly perceived and intertwined affects, could cause total ecosystem collapse and human extinction. Each new extinction increases the risk of disaster. Like a mechanic removing, one by one, the rivets from an aircraft's wings, n80 mankind may be edging closer to the abyss.

Prolif Leads to Nuclear War Utgoff, PhD from Purdue University, 02

(Victor Utgoff, PhD, Deputy Director for the Strategy, Forces, & Resources Division of the Institute for Defense Analysis former senior member of the National Security Council staff, Summer, Survival, Vol. 44 #2, P. 87-90)

the dynamics of getting to a highly proliferated world could be very dangerous. Proliferating states will feel great pressures to obtain nuclear weapons and delivery systems before any potential opponent does. Those who succeed in outracing an opponent may consider preemptive nuclear war before the opponent becomes capable of nuclear retaliation. Those who lag behind might try to preempt their opponent's nuclear programme or defeat the opponent using conventional forces. And those who feel threatened but are incapable of building nuclear weapons may still be able to join in this arms race by building other types of weapons of mass destruction, such as biological weapons. Second, as the world approaches complete proliferation, the hazards posed by nuclear weapons today will be magnified many times over. Fifty or more nations capable of launching nuclear
First, weapons means that the risk of nuclear accidents that could cause serious damage not only to their own populations and environments, but those of others, is hugely increased. The chances of such weapons falling into the hands of renegade military units or terrorists is far greater, as is the number of nations carrying out hazardous manufacturing and storage activities. Increased prospects for the occasional nuclear shootout Worse still, in a highly proliferated world there would be more

frequent opportunities for the use of nuclear weapons. And more frequent opportunities means shorter expected times between conflicts in which nuclear weapons get used, unless the probability of use at any opportunity is actually zero. To be sure, some theorists on nuclear deterrence appear to think that in any confrontation between two states known to have reliable nuclear capabilities, the probability of nuclear weapons being used is zero.' These theorists think that such states will be so fearful of escalation to nuclear war that they
would always avoid or terminate confrontations between them, short of even conventional war. They believe this to be true even if the two states have different cultures or leaders with very eccentric personalities. History and human nature,

however, suggest that they are almost surely wrong. History includes instances in which states known to possess nuclear weapons did engage in direct conventional conflict. China and Russia fought battles along
their common border even after both had nuclear weapons. Moreover, logic suggests that if states with nuclear weapons always avoided conflict with one another, surely states without nuclear weapons would avoid conflict with states that had them. Again, history provides counter-examples. Egypt attacked Israel in 1973 even though it saw Israel as a nuclear power at the time. Argentina invaded the Falkland Islands and fought Britain's efforts to take them back, even though Britain had nuclear weapons.Those who claim that two states with reliable nuclear capabilities to devastate each other will not engage in conventional conflict risking nuclear war also assume that any leader from any culture

would not choose suicide for his nation. But history provides unhappy examples of states whose leaders

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were ready to choose suicide for themselves and their fellow citizens. Hitler tried to impose a 'victory or
destruction' policy on his people as Nazi Germany was going down to defeat.' And Japan's war minister, during debates on how to respond to the American atomic bombing, suggested 'Would it not be wondrous for the whole nation to be destroyed like a beautiful flower?" If leaders are willing to engage in conflict with nuclear-

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armed nations, use of nuclear weapons in any particular instance may not be likely, but its probability would still be dangerously significant. In particular, human nature suggests that the threat of retaliation with nuclear weapons is not a reliable guarantee against a disastrous first use of these weapons. While
national leaders and their advisors everywhere are usually talented and experienced people, even their most important decisions cannot be counted on to be the product of well-informed and thorough assessments of all options from all relevant points of view. This is especially so when the stakes are so large as to defy assessment and there are substantial pressures to act quickly, as could be expected in intense and fast-moving crises between nuclear-armed states .6 nstead, like other human beings, national leaders can be seduced by wishful thinking. They can misinterpret the words or actions of opposing leaders. Their advisors may produce answers that they think the leader wants to hear, or coalesce around what they know is an inferior decision because the group urgently needs the confidence or the sharing of responsibility that results from settling on something. Moreover, leaders may not recognise clearly where their personal or party interests diverge from those of their citizens. Under great stress, human beings can lose their ability to think carefully. They can refuse to believe that the worst could really happen, oversimplify the problem at hand, think in terms of simplistic analogies and play hunches. The intuitive rules for how individuals should respond to insults or signs of weakness in an opponent may too readily suggest a rash course of action. Anger, fear, greed, ambition and pride can all lead to bad decisions. The desire for a decisive solution to the problem at hand may lead to an unnecessarily extreme course of action. We can almost hear the kinds of words that could flow from discussions in nuclear crises or war. 'These people are not willing to die for this interest'. 'No sane person would actually use such weapons'. 'Perhaps the opponent will back down if we show him we mean business by demonstrating a willingness to use nuclear weapons'. 'If I don't hit them back really hard, I am going to be driven from office, if not killed'. Whether right or wrong, in the stressful atmosphere of a nuclear crisis or war, such words from others, or silently from within, might resonate too readily with a harried leader . Thus, both history and human nature suggest that nuclear deterrence can be expected to fail from time to time , and we are fortunate it has not happened yet. But the threat of nuclear war is not just a matter of a few weapons being used . It could get much worse. Once a conflict reaches the point where nuclear weapons are employed, the stresses felt by the leaderships would rise enormously. These stresses can be expected to further degrade their decision-making. The pressures to force the enemy to stop fighting or to surrender could argue for more forceful and decisive military action , which might be the right thing to do in the circumstances, but maybe not. And the horrors of the carnage already suffered may be seen as justification for visiting the most devastating punishment possible on the enemy.' Again, history demonstrates how intense conflict can lead the combatants to escalate violence to the maximum possible levels. In the Second World War, early promises not to bomb cities soon gave way to essentially indiscriminate bombing of civilians. The war between Iran and Iraq during the 1980s led to the use of chemical weapons on both sides and exchanges of missiles against each other's cities. And more recently, violence in the Middle East escalated in a few months from rocks and small arms to heavy weapons on one side, and from police actions to air strikes and armoured attacks on the other. Escalation of violence is also basic human nature. Once the violence starts, retaliatory exchanges of violent acts can escalate to levels unimagined by the participants beforehand.' Intense and blinding anger is a common response to fear or humiliation or abuse. And such anger can lead us t0 impose on our opponents whatever levels of violence are readily accessible. In sum, widespread proliferation is likely to lead to an occasional shoot-out with nuclear weapons, and that such shoot-outs will have a substantial probability of escalating to the maximum destruction possible with the weapons at hand. Unless nuclear proliferation is stopped, we are headed toward a world that will mirror the American Wild West of the late 1800s. With most, if not all, nations wearing nuclear 'six-shooters' on their hips, the world may even be a more polite place than it is today, but every once in a while we will all gather on a hill to bury the bodies of dead cities or even whole nations. This kind of world is in no nation's interest. The means for preventing it must be pursued vigorously. And, as argued above, a most powerful way to prevent it or slow its emergence is to encourage the more capable states to provide reliable protection to others against aggression, even when that aggression could be backed with nuclear weapons. In other words, the world needs at least one state, preferably several, willing and able to play the role of sheriff, or to be members of a sheriff's posse, even in the face of nuclear threats. A world of proliferation

eliminates all current checks on nuclear warfare (popular dissent, logic, alliances etc) ensuring inumerable nuclear conflict to magnitudes unimaginable in the status quo.

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Scenario Two is Mexico Collapse: Drug Wars makes Mexico Collapse Inevitable Macdonald, Staff Writer for the Trumpet Magazine, 09
(Brad Macdonald, Mexico : Bordering on Collapse Trumpet.com, January 29th 2009, http://www.thetrumpet.com/?q=5887.4259.0.0

According to Mexicos attorney general, 6,616 people died in drug-trafficking violence in Mexico last year, the Wall Street Journal reported this week. Thats in one year. A high percentage of those killed were themselves criminal, but many law enforcement agents battling organized crime were also murdered. The carnage continues. For the first 22 days of this year the body count is 354 (emphasis mine throughout). The number of deaths in 2008 was double the figure for 2007. This trend is indicative of a major crisis. Mexico is coming unhinged. Drug cartels have stepped up their war against the Mexican government since December 2006, when President Felipe Caldern was elected and began a campaign to destroy organized crime. As soon as Caldern began confronting the cartels, observed the Journal, it became apparent that the cartels would stop at nothing to preserve their operations, and that a state commitment to confrontation meant that violence would escalate. Escalate it did. Emboldened by billion-dollar bank
accounts, vast recruitment pools of countless unemployed, desperate Mexicans, friendship with international crime organizations, support from major-league weapons suppliers, and, above all, an insatiable American demand for their supply, Mexicos drug cartels in recent years have transformed into well-equipped, well-organized, technologically advanced, highly mobile, powerful armies! Thats no exaggeration. Retired U.S. Army general and former drug czar Barry McCaffrey, who recently visited Mexico, assessed the struggle between the

government and the drug kingdoms thus: The outgunned Mexican law enforcement authorities face armed criminal attacks from platoon-sized units employing night vision goggles, electronic intercept collection, encrypted communications, fairly sophisticated information operations, seagoing submersibles, helicopters and
modern transport aviation, automatic weapons, RPGs, Anti-Tank 66mm rockets, mines and booby traps, heavy machine guns, 50-cal sniper rifles, massive use of military hand grenades, and the most modern models of 40mm grenade machine guns. These illegal drug cartels are better-financed, better-equipped and better-organized than some national armies! And thats not half the story. In addition to their impressive firepower and taste for brutality, both of which they have proven willing to use, these organizations have nfiltrated deep within the Mexican government.

Corruption infects the government like cancer, giving the drug lords a decisive advantage over Caldern and his dreams of squelching Mexicos drug trade. Last October, for example, 35 employees of the Office of the Mexican Attorney Generals anti-organized-crime unit were arrested and charged with corruption. Its widely recognized that corruption riddles lower levels of the Mexican government, especially in states, cities and towns along the U.S. border through which drugs flow incessantly, but these arrests proved that even the
upper echelons of government are not out of the reach of cartels. After the arrests, it emerged that the top officials were paid up to $450,000 per monthto funnel information to the drug lords. In Mexico, local police officers make around $10,000 per year, senators around $48,000, and the president $220,000. Corruption is inevitable when government employees can potentially earn more in a monthprotecting and facilitating the work of the cartels than they do in an entire year working against them for the government. In some smaller towns, the loyalty of the entire police force has been purchased for a few hundred thousand dollars. In some cases, the support of entire towns has been purchased by cash-rich drug cartels promising to take care of loyal townsfolk. Further evidence of the cartels reach emerged last November, when No Ramrez Mandujano, a lead figure in the Mexican governments anti-drug campaign, was arrested on suspicion of accepting a $450,000 payoff from a drug cartel he was supposed to be hunting down. Manuel Mondragon, a senior police officer in Mexico City, admitted that a spiderweb of corruption has penetrated many parts of our department. Corruption plagues every nook and cranny of the Mexican government, from local police officers to police chiefs to mayors to judges to the attorney generals office to members of the military! Rejecting a cartels advances is virtually impossible particularly when remaining loyal to Caldern could result in the loss of your head! Even President Caldern is not safe. Reporting on the chaos in Mexico, the Telegraph in London reported earlier this month that an officer in the elite

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presidential guard was recently accused of taking thousands of dollars from traffickers in exchange for reports on President Calderns movements. Analysts at Stratfor have been tracking the deteriorating situation in Mexico for more than two years. Last December they explained the reason for, and the sobering extent of, the corruption within the Mexican government: The problem of corruption boils down to the lure of money and the threat of death. Known by the phrase plata o plomo (which literally translates to silver or lead, with the implied meaning, take a bribe or take a bullet), the choice given to law enforcement and government officials puts them under the threat of death if they do not permit (or, as is often the case, facilitate) cartel operations. With the government historically unable to protect all of its personnel

from these kinds of threatsand certainly unable to match the cartels deep pocketsMexicos law enforcement officials have become almost universally unreliable. No wonder President Caldern is losing his war to the drug cartels: Mexicos law enforcement system is being infiltrated, undermined and hijacked by the drug cartels! Theres a term for a state that is incapable of enforcing law. Its a failed state! And that is what many are saying Mexico is on the road to becoming. In America, the U.S. Department of Homeland Security, the Department of Justice and the National Security Council have all, in one way or another, recently expressed alarm that Mexico could collapse under the strain of drug cartel violence. In its 2009 National Drug Threat Assessment, released on December 15, the U.S. Department of Justice stated that Mexican drug traffickers represent the greatest organized crime threat to the United States. With that statement, said Stratfor, the Justice Department is acknowledging that Mexican drug cartels are the number-one criminal enemy of the U.S. governmenta position held in the past by Irish, Italian, Russian and Colombian criminal enterprisesa reality that has been extant for some time (Dec. 17, 2008). The U.S. Joint Forces Command released a similar warning recently. In terms of worst-case scenarios for the Joint Force and indeed the world, warned the commands Joint Operating
Environment (JOE 2008) report, two large and important states bear consideration for a rapid and sudden collapse: PAKISTAN AND MEXICO . In particular, the growing assault by the drug cartels and their thugs on the

Mexican government over the past several years reminds one that an unstable Mexico could represent a homeland security problem of immense proportions to the United States.

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Giving immigrants access to healthcare is critical to winning the war on drugs Schulz, Senior Fellow at the Center for American Progress, 09
(William F. Schultz, to Adjunct Professor of International Relations at The New School, June 2009, The Power of Justice, Center for American Progress, http://www.americanprogress.org/issues/2009/06/pdf/humanrights.pdf [Abhik]) It almost goes without saying at this point that the many violations of international law and standards carried out in the name of combating terrorism have done enormous damage to Americas reputation. In 1998, 59 percent of citizens in Great Britain and 61 percent in Germanytwo of the United States staunchest alliessaid America was doing a good job in advancing human rights around the world. By 2006, due to Guantanamo Bay, Abu Ghraib, and other markers of disdain for human rights, those numbers had fallen to 22 percent and 24 percent respectively.32 When Muslims are subjected to racial profiling, such discriminatory treatment makes it easier for Al Qaeda to characterize the United States response to terrorism as a war on Islam. In 2002, for example, the Immigration and Naturalization Service required male visitors to the United States from 25 countriesall of them Arab and Muslim except North Koreato be fingerprinted, photographed, and questioned by authorities. And in 2005 the FBI conducted radiation testing of large numbers of American mosques in the absence of evidence of criminal activity.33 Similarly, just as the Soviet Union once reaped benefits from exploiting the existence of racial discrimination in the United States, so the Chinese have a field day

every year responding to the State Departments criticisms of Chinese human rights abuses by citing American failings. These include the practice of sentencing children to life in prison without parole or the fact that the number of people living in poverty in the United States increased from 36.5 million in 2006 to 37.3 million in 2007. The latter citation indicates that shortcomings in the area of social and economic rights can also have implications for U.S. foreign policy goals. If the United States, for example, recognized a human right to health, it is likely that its approach to the drug wars would focus far more on prevention and treatment than punishment and prison time. That, in turn, would diminish the market for illegal drugs that fuels narcotrafficking, violence on the southern border, and instability in Mexico.

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The Collapse of Mexico will lead to the withdrawal of the U.S. from the international system Haddick, Editor of the Small Arms Journal, 08 (Robert Haddick, MBA, Former Director of Research at the Fremont Group, former Marine Corps Officer, his articles have been previously published in prestigious publications such as the New York Post and The Wall Street Journal, Now that would change everything, December 21st 2008, http://westhawk.blogspot.com/2008/12/now-thatwould-change-everything.html [Abhik])

There is one dynamic in the literature of weak and failing states that has received relatively little attention, namely the phenomenon of rapid collapse. For the most part, weak and failing states represent chronic, long-term problems that allow for management over sustained periods. The collapse of a state usually comes as a surprise, has a rapid onset, and poses acute problems. The collapse of Yugoslavia into a chaotic tangle of warring nationalities in 1990 suggests how suddenly and catastrophically state collapse can happen - in
this case, a state which had hosted the 1984 Winter Olympics at Sarajevo, and which then quickly became the epicenter of the ensuing civil war. In terms of worst-case scenarios for the Joint Force and indeed the world, two large and important states bear consideration for a rapid and sudden collapse: Pakistan and Mexico. Some forms of collapse in Pakistan would carry with it the likelihood of a sustained violent and bloody civil and sectarian war, an even bigger haven for violent extremists, and the question of what would happen to its nuclear weapons. That perfect storm of uncertainty alone might require the engagement of U.S. and coalition forces into a situation of immense complexity and danger with no guarantee they could gain control of the weapons and with the real possibility that a nuclear weapon might be used. The Mexican possibility may seem less likely, but the government, its politicians, police, and

judicial infrastructure are all under sustained assault and pressure by criminal gangs and drug cartels. How that internal conflict turns out over the next several years will have a major impact on the stability of the Mexican state. Any descent by the Mexico into chaos would demand an American response based on the serious implications for homeland security alone. Yes, the rapid collapse of Mexico would change everything with respect to the global security environment. Such a collapse would have enormous humanitarian, constitutional, economic, cultural, and security implications for the U.S. It would seem the U.S. federal government, indeed American society at large, would have little ability to focus serious attention on much else in the world. The hypothetical collapse of Pakistan is a scenario that has already been well discussed. In the worst case, the U.S. would be able to isolate itself from most effects emanating from south Asia. However, there would be no running from a Mexican collapse.

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U.S. withdrawal from the international system risks the collapse of the economy, widespread prolif and world war Khalilzad, Counselor at CSIS, 95
(Zalmay Khalilzad, Counselor at the Center for Strategic and International Studies, Former U.S. Ambassador to the United Nations, Afghanistan and Iraq. Losing the Moment? The United States and the World After the Cold War. The Washington Quarterly, Vol. 18, No. 2. pg. 84 Spring 1995) Realistically and over the longer term, however, a neo-isolationist approach might well increase the danger of major conflict, require a greater U.S. defense effort, threaten world peace, and eventually undermine U.S. prosperity. By withdrawing from Europe and Asia, the United States would deliberately risk weakening the institutions and solidarity of the world's community of democratic powers and so establishing favorable conditions for the spread of disorder and a possible return to conditions similar to those of the first half of the twentieth century. In the 1920s and 1930s, U.S. isolationism had disastrous consequences for world peace. At that time, the United States was but one of several major powers. Now that the U nited States is the world's preponderant power, the shock of a U.S. withdrawal could be even greater. What might happen to the world if the United States turned inward? Without the United States and the North Atlantic Treaty Organization (NATO), rather than cooperating with each other, the West European nations might compete with each other for domination of East-Central Europe and the Middle East. In Western and Central Europe, Germany -- especially since unification -- would be the natural leading power. Either in cooperation or competition with Russia, Germany might seek influence over the territories located between them. German efforts are likely to be aimed at filling the vacuum, stabilizing the region, and precluding its domination by rival powers. Britain and France fear such a development. Given the strength of democracy in Germany and its preoccupation with absorbing the former East Germany, European concerns about Germany appear exaggerated. But it would be a mistake to assume that U.S. withdrawal could not, in the long run, result in the renationalization of Germany's security policy. The same is also true of Japan. Given a U.S. withdrawal from the world, Japan would have to look after its own security and build up its military capabilities. China, Korea, and the nations of Southeast Asia already fear Japanese hegemony. Without U.S. protection, Japan is likely to increase its military capability dramatically -- to balance the growing Chinese forces and still-significant Russian forces. This could result in arms races, including the possible acquisition by Japan of nuclear weapons. Given Japanese technological prowess, to say nothing of the plutonium stockpile Japan has acquired in the development of its nuclear power industry, it could obviously become a nuclear weapon state relatively quickly, if it should so decide. It could also build long-range missiles and carrier task forces. With the shifting balance of power among Japan, China, Russia, and potential new regional powers such as India, Indonesia, and a united Korea could come significant risks of preventive or proeruptive war. Similarly, European competition for regional dominance could lead to major wars in Europe or East Asia. If the United States stayed out of such a war -- an unlikely prospect -- Europe or East Asia could become dominated by a hostile power. Such a development would threaten U.S. interests. A power that achieved such dominance would seek to exclude the United States from the area and threaten its interests-economic and political -- in the region. Besides, with the domination of Europe or East Asia, such a power might seek global hegemony and the United States would face another global Cold War and the risk of a world war even more catastrophic than the last. In the Persian Gulf, U.S. withdrawal is likely to lead to an intensified struggle for regional domination. Iran and Iraq have, in the past, both sought regional hegemony. Without U.S. protection, the weak oil-rich states of the Gulf Cooperation Council (GCC) would be unlikely to retain their independence. To preclude this development, the Saudis might seek to acquire, perhaps by purchase, their own nuclear weapons. If either Iraq or Iran controlled the region that dominates the world supply of oil, it could gain a significant capability to damage the U.S. and world economies. Any country that gained hegemony would have vast economic resources at its disposal that could be used to build military capability as well as gain leverage over the United States and other oil importing nations. Hegemony over the Persian Gulf by either Iran or Iraq would bring the rest of the Arab Middle East under its influence and domination because of the shift in the balance of power. Israeli security problems would multiply and the peace process would be fundamentally undermined, increasing the risk of war between the Arabs and the Israelis. The extension of instability, conflict, and hostile hegemony in East Asia, Europe, and the Persian Gulf would harm the economy of the United States even in the unlikely event that it was able to avoid involvement in major wars and conflicts. Higher oil prices would reduce the U.S. standard of living. Turmoil in Asia and Europe would force major economic readjustment in the United States, perhaps reducing U.S. exports and imports and jeopardizing U.S. investments in these regions. Given that total imports and exports are equal to a quarter of U.S. gross domestic product, the cost of necessary adjustments might be high. The higher level of turmoil in the world would also increase the likelihood of the proliferation of weapons of mass destruction (WMD) and means for their delivery. Already several rogue states such as North Korea and Iran are seeking nuclear weapons and long-range missiles. That danger would only increase if the United States withdrew from the world. The result would be a much more dangerous world in which many states possessed WMD capabilities; the likelihood of their actual use would increase accordingly. If this happened, the security of every nation in the world, including the United States, would be harmed.

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Observation Two is solvency: Congressional Repealing of Section 434 of PRWORA and Section 642 of the Immigration Reform Law is critical to letting immigrants access healthcare Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

The first, and most essential step of the recommendation process requires Congress to repeal Section 434 of the Welfare Reform Act and Section 642 of the Immigration Reform Law. This step is of vital importance because these sections have created an indirect roadblock for illegal immigrants accessing federally or state funded health care because they are not shielded from having their immigration status reported to the INS by health care officials. Repealing this legislation is the touchstone of providing illegal immigrants with undeterred publicly funded health care because if these sections remain in existence, states will not have the ability to provide illegal immigrants with security when they choose to access the available federally funded care and nor will states be effectively granted the power to provide illegal immigrants with preventive care. Congress should not have a problem repealing these sections because the [*586] objectives behind this legislation are unjustifiable. n123 Legislation proposing the reporting of immigration status of illegal immigrants when they attempt to access public, social services has a myriad of objectives. These objectives
include: First, illegal immigrants would be deterred from accessing public services if they fear being reported to the INS and subsequently deported. Second, with more information on persons believed to be in the United States illegally, the INS would be able to deport more persons. Third, as part of broader anti-immigration programs, the mandatory reporting schemes aim to deter the flow of illegal immigrants into the United States and encourage those already here to return to their home countries. Currently, there are approximately 8 million illegal immigrants in the United States. n125 In 1995, the federal government deported 1,200 illegal immigrants. n126 Even if these objectives were successful to the point where it increased the number of deportations by an overwhelming ten-fold to 12,000 deportations per year, this would still leave the majority of illegal immigrants in the United States. n127 If there is a significant increase in the number of deportations, the number will be nullified by the illegal immigrants that are bound to enter into the United States in the meantime. n128 In essence, these objectives are meaningless towards decreasing the number of illegal immigrants through

deportation. Even if the INS received a substantial increase in the names of illegal immigrants, history reveals that the INS is unlikely to apprehend and deport a number of illegal immigrants that would make any sort of significant impact. n129 Former New York City Mayor Rudolph Giuliani addressed the shortcomings of this
legislation that is supposedly intended to help the problem with illegal immigrants. n130 In New York City, there are approximately 2,500 undocumented illegal immigrants in their prisons. n131 Furthermore, nearly 4,000 illegal immigrants go through the New York City jail [*587] system every year. n132 Although the names of these illegal immigrants are handed over to the INS for deportation, the INS successfully deported merely 300 of these convicted felons. n133 Therefore, the INS already has a significant source of illegal immigrants they could deport but have chosen not to. "The Federal Government does not deport enough illegal aliens in any given year to put a dent in the illegal population." n134 Should legislation be aimed at deporting desperate, innocent illegal immigrants seeking health care, when the INS already has more than enough names of felon illegal immigrants to deport with their current funding? n135 The answer is no. Instead of

meeting the intended objective of deporting illegal immigrants, these sections only create a situation where poor, uninsured, illegal immigrants must fear going to public health care facilities and obtaining other essential social services. If this legislation is to be justified, deportation, not depriving these people from basic social services, must be the legitimate interest that the federal government is trying to accomplish. Creating indirect fear for illegal immigrants seeking much needed public health care services causes problems that are not justified by the federal government's modest number of deportations.

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Specifically, Congressional Action is key to prevent deportation of Immigrants once they get healthcare Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

Illegal immigrants, a growing, substantial portion of the United States population, face a wide range of challenges because of language, cultural, and financial barriers. Due to these barriers, they are often uninsured, impoverished, and encounter poor working and living conditions. Among these barriers is their inability to obtain reasonable access to publicly funded health care, even for emergencies and infectious diseases. Illegal immigrants are in this dilemma because federal legislation has fully stripped them of access to preventive care and created the possibility of deportation if they choose to access the available care for emergencies and communicable [*592] diseases. The same legislation also granted states the power to draft and pass affirmative legislation to provide illegal immigrants with state-funded, preventive health care. However, illegal immigrants must remain fearful of potential deportation if they choose to access it. Since illegal immigrants are deterred from obtaining state-funded health care, they are more likely to wait until their condition, whether infectious or not, is at an emergency level. Placing illegal immigrants in this insecure situation, where accessing publicly funded health care almost becomes a last resort, creates a myriad of problems not only for the illegal immigrant population, but for the general population as well. The general population, especially in crowded metropolises with a substantial number of illegal immigrants, is placed at a greater risk of becoming infected with communicable diseases. Health care officials are also left in confusion
regarding whether or not to report undocumented aliens, especially when they are untrained to act as INS agents. From an economic standpoint, indirectly forcing illegal immigrants to wait until their conditions are at emergency levels to seek treatment is inefficient because emergency care, which the government is required to provide, costs nearly four to tent times as much as providing preventive care. Another economic burden rests with the high cost of treating birth defects among children of illegal immigrants, who become United States citizen at birth. This cost could be avoided with proper prenatal care, but illegal immigrant mothers are either denied this service completely or are deterred from accessing it. Legislative

reform can help solve the numerous problems associated with illegal immigrants and their inability to access health care. Reform must start with the federal government by repealing legislation that bans state officials from preventing their state officials from sharing information with the INS. Next, states must utilize
this regained authority and pass limited cooperation ordinances in order to provide security for illegal immigrants that desire to access care. Finally, states should utilize their authority and pass legislation providing, at least, prenatal care and treatment for chronic and debilitating diseases. It should be duly noted that legislative reform is not going to be a "cure-all" for every problem associated with illegal immigrants and their ability to access and receive proper health care by any means. However, legislative reform would provide part of the solution to arguably the most important

problem regarding health care for the illegal immigrants, barriers to access.

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1AC
Institutions under state funding face litigationthis deters hospitals from helping immigrants Kullgren, Clinical Fellow at Harvard Med School, 03
(Jeffery T. Kulgren, M.D., MPH, Clinical Fellow in Medicine at Harvard Medical School, October 2003, American Journal of Public Health Vol. 93 No. 10, http://www.ajph.org/cgi/reprint/93/10/1630) The consequences of undocumented immigrants health burdens and barriers to accessing services extend beyond the individual to the entire community. The agricultural and food service settings in which many undocumented immigrants work, for example, can facilitate the spread of communicable diseases to other segments of the population. 6 Johns and Varkoutas also suggest that fear of detection has driven undocumented immigrants to pursue treatments through underground channels, which may have helped fuel the emergence of drug-resistant microbes.8For the most part, PRWORAs limitations on the provision of health services to undocumented immigrants have not been embraced by state and local officials. In light of the threats that undocumented immigrants health conditions pose to communities, relatively few local jurisdictions have established policies explicitly limiting provision of health services based on immigration status.9 Many publicly supported health care institutions in Texas, for example, have long provided free and discounted nonemergency care to all residents, even after the enactment of welfare reform legislation.10 There are, however, a few notable exceptions to this trend, including institutions in San Diego, Albuquerque, and Fort Worth.9,11 In response to the ambiguity generated by this seemingly pervasive disconnection between policy and practice, administrators of the Harris County Hospital District, which includes the city of Houston and constitutes the third-busiest public health care system in the United States, sought guidance from Texas Attorney General John Cornyn in late 2000 to ascertain whether its proposed payment policy revisions (which would have permitted the district to provide free or discounted care to anyone who could show county residency and financial need) violated PRWORA and to determine the possible penalties for any such violations .12 Attorney General Cornyns subsequent opinion concluded that the welfare reform law prohibits the district from providing free or discounted nonemergency health care to undocumented immigrants, even if they reside within the districts boundaries, and that no state laws enacted since 1996 expressly state the legislatures intent that undocumented aliens are to be eligible for certain public benefits.13 With respect to potential penalties, the attorney general decided that, while PRWORA does not explicitly describe a penalty for providing public benefits to undocumented immigrants, there may be sanctions to the district pursuant to conditions attached to federal funding and that there may also be legal consequences pursuant to state law for spending public funds for an unauthorized purpose.13 Cornyns opinion has stirred an intense debate both in Texas and around the nation. Some of the states local advocates and district attorneys have pressed for public inquiries into the activities of jurisdictions that choose to continue to provide free and discounted services; in Harris County, the local district attorney initiated a criminal investigation of the hospital district and its leadership.14 Fearful of similar investigations in their own jurisdictions, some health care institutions in Nueces County, which includes Corpus Christi, and Montgomery County, just outside of Houston, have chosen to limit the services provided to undocumented individuals rather than leave their organizations and administrators exposed to prosecution. 9,10 Other parties that support hospitals long-standing policies have obtained alternative legal interpretations of applicable state and federal laws that they claim justify the continued provision of discounted services to all residents irrespective of immigration status.15 While Harris Countys district attorney has withdrawn his criminal investigation in an effort to achieve a workable compromise with health administrators, and calls for the initiation of similar inquiries around the state appear to have subsided, Attorney General Cornyns opinion still stands to shape public health policy regarding undocumented immigrants not only in Texas but across the country.16 Attorneys general and local prosecutors in other jurisdictions may draw on the opinion to initiate legal action against institutions that provide discounted services irrespective of immigration status. Should a court uphold Cornyns opinion and related legal challenges, institutions that have not amended their policies to accommodate PRWORAs restrictions may face increased scrutiny. Institutions in states such as California and New York, which have relatively large undocumented populations but so far appear to have been spared from legal inquiries, could conceivably be the next targets. Even if other jurisdictions policies are not contested in court, the Cornyn opinion itself may have a chilling effect by discouraging undocumented immigrants from accessing health care as well as discouraging individual institutions from providing discounted services to undocumented populations.

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Inherency
Illegal immigrants lack healthcare in the status quo Brooks, J.D. candidate, 1995
[Cynthia Webb Brooks, J.D. candidate, Houston Journal of International Law, "Health Care Reform, Immigration Laws, and Federally Mandated Medical Services: Impact of Illegal Immigration" p. 141--76]) While the fervent public debate regarding the costs associated with the illegal alien population continues, the fact remains that the undocumented alien is nonetheless a person with rights and needs. Because they must often live in substandard conditions , illegal aliens are particularly susceptible to a variety of serious health problems.155 Moreover, the undocumented immigrant is likely to be working in a high risk job.156 Generally, illegal aliens do not have health insurance or available financial resources to procure routine, preventive care.157 Undocumented individuals continually live with the fear of deportation because of their illegal status.158 This fear often prevents them from seeking any type of medical care.159 Therefore, they arrive most often in emergency rooms only after the medical situation has elevated to a crisis.160

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Inherency
Immigrants are denied health care Berdion, Writer for the SMU Law Review, 08
(Marcela X. Berdion, Writer for the SMU Law Review, The right to health care in the United States: local answers to global responsibilities., SMU law review, Volume 60, issue 14, pg. 1633-1666, December 28th 2008) By passing EMTALA, Congress recognized the value of at least a certain level of health care for all humans, and perhaps it intended to codify those rights, but it has not since fulfilled its international responsibilities and has instead erected further barriers to health care access for certain individuals it has deemed unworthy to receive care. 2. The Lack of Non-Emergency Care Rights and

PRWORA Access to emergency screening in hospitals and stabilization before being transferred does not rise to a level that meets the international standards dictating a right to health for immigrants in the United States who lack insurance. The uninsured do not receive regular medical care both because of the high costs of health care in the country and because doctors may and often do refuse to treat the uninsured, leaving hospital emergency rooms as their primary

source of care. n84 Uninsured aliens especially are less likely to receive preventative, prenatal, and other non-emergency medical care and frequently go to hospital emergency rooms for illnesses that could have been prevented with prior care. n85 Instead of ameliorating these problems by providing greater access to nonemergency health care for all people, including immigrants, Congress in 1996 took a major step away from recognizing a human right to health when it enacted the Personal Responsibility and Work Opportunity Reconciliation Act of 1966 (PRWORA, or 1996 Welfare Reform Act), n86 leaving [*1648] thousands of alien immigrants without government health insurance and thus without care. n87 Congress passed PRWORA with an intent to eliminate public benefits for illegal immigrants, since the statute denies state and local benefits to unqualified aliens. n88 The Act defines qualified aliens as including Lawful Permanent Residents ("LPRs"), asylees and refugees, among others, but intentionally excludes undocumented aliens. n89 It also does not cover temporary residents (nonimmigrants), aliens granted temporary protected status, Family Unity beneficiaries, spouses and children with pending adjustment of status claims, cancellation of removal and asylees applicants, and several other categories of aliens in the United States. n90 The Act erects a barrier to health care for immigrants by denying state and local benefits for ineligible aliens and provides exceptions only for emergency care, immunizations, treatment for communicable diseases, disaster relief, and programs which may be specified by the Attorney General. n91 PRWORA does, however, allow states to pass legislation "which affirmatively provides ... eligibility" to undocumented immigrants for any state or local benefits, n92leaving immigrants at the will of the legislatures and sentiments toward immigrants in the individual states in which they reside to provide them with a way to access nonemergency care. Additionally, PRWORA further hindered immigrant access to care by enacting waiting periods for immigrants to receive Medicaid benefits. The Act prescribes that LPRs who entered the country after August 22, 1996 can only apply for Medicaid benefits after five years of having entered the country legally, and can only receive benefits at states' discretion, as is the case for LPRs who were in the country as of August 22, 1996. n93 Under PROWRA, refugees and asylees are not eligible for Medicaid assistance until seven years after their date of entry, and, as previously discussed, all aliens holding legal

nonimmigrant status as well, as all undocumented immigrants, are completely barred from receiving assistance through these programs.

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Inherency
Poor immigrants dont get health care even if they want it Kaiser Commission, 03
Kaiser Commission, Medicaid and the Uninsured, Aug. 2003<http://www.kff.org/uninsured/upload/Immigrants-Health-CareCoverage-and-Access-fact-sheet.pdf>

Immigrants are an integral part of the U.S. society, contributing both to the economy and diversity of the country. Despite their important role, immigrants disproportionately lack health coverage and receive fewer health services than native-born citizens. The disparities confronting immigrants are similar to those faced by low-income working families generally,
but immigrants also face other barriers including the recent policy changes that have limited their ability to qualify for Medicaid. As policymakers discuss the nations growing number of uninsured and issues of access and quality, coverage issues for the noncitizen U.S. population will need to be addressed. IMMIGRANTS IN THE U.S. In 2000, there were over 32 million foreign-born residents in the U.S (11% of the total U.S. population). These immigrants fall into one of several categories depending on how they came to the U.S. and their current citizenship status (Figure 1). Most immigrants (73%) are here legally. Undocumented aliens, many of whom entered legally but overstayed their visas, account for 27 percent. Almost one-third are naturalized citizens and most immigrant families (85%) contain children that are U.S. citizens. Non-citizen families are much more likely to be poor than those in citizen families even though they are just as likely to have a full-time worker in their family. They are much more likely to work for a small business and work in agricultural, labor and repair industries (Figure 2). Six states account for 7 in 10 immigrants: California was home for almost a third of all immigrants (30%) and another 40 percent resided in New York, Florida, Texas, Illinois, and New Jersey in 2000. North Carolina, Nevada, Kansas, and Indiana have all experienced large increases (more than 50%) in their immigrant population since 1995. IMMIGRANTS AND HEALTH COVERAGE Lack of

health insurance coverage is a major issue facing immigrant populations. Low-income non-citizens are more than twice as likely to be uninsured as low-income citizens. Of the 11 million low-income non-citizens, 60 percent had no health insurance in 2001 and only 13 percent received Medicaid. In contrast, about 28 percent of low-income citizens were
uninsured and about 30 percent had Medicaid (Figure 3). Medicaid, the nations major health coverage for low-income people, plays an important role for immigrants because of their high poverty rates and lack of workplace coverage. Low-income non-citizen children are much more likely to receive Medicaid than non-citizen adults because Medicaid typically covers children at higher income levels (Figure 3). However, Medicaid coverage has been declining for non-citizens --- in 1995, 19 percent of lowincome non-citizens received Medicaid compared to 13 percent in 2001. Over the same time, uninsured rates for low-income noncitizens have increased from 54 to 60 percent. Non-citizens are more likely to be uninsured than citizens but they comprise only 21 percent of the 41 million uninsured in U.S in 2001.

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Poor Immigrants lack HC

Impoverished immigrants lack healthcare Wang, fellow at Century Foundation, 01
(Tova Andrea Wong, democracy fellow at The Century Foundation, is vice president for research at Common Cause, 1/1/2001, http://www.immigrationline.org/publications.asp?pubid=405)

many legal immigrants do not have any health insurance, putting proper medical care often out of reach. Welfare reform exacerbated this situation . After passage, the percentage of lowincome immigrants who had no health insurance coverage from any source rose by 6 to 7 percent points between 1995 and 2000.19 The number of immigrants receiving Medicaid fell between 7 and 8 percent between 1995 and 2000.20 Among
In addition to being disproportionately poor, low-income working age adult legal immigrants, Medicaid use declined by 23 percent. The Urban Institute found that this was not because immigrants acquired other forms of insurance, but rather lost health insurance altogether. 31.6 percent of working age adult citizens lacked health insurance in 1999, while 56.3 percent of working age adult legal immigrants were uninsured.21 Moreover, this lack of access to health insurance proved disproportionately damaging to immigrant children. Participation in the Medicaid program by legal immigrant families declined between 1994 and 1999 by 15 percent.22 While 46 percent of low income noncitizen children lacked health insurance in 1999, only 20 percent of children with native-born parents had no health coverage. Children in immigrant families account for nearly one-third of low income children who have no health insurance in this country.23 A recent study found that applications for Medicaid declined among immigrants in part because immigrants were afraid to apply for Medicaid, there was a lack of information on eligibility for immigrants, and immigrants were misdirected by welfare offices.24

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No HCImmigrants Get Sick

Healthy immigrants sicken due to lack of health care
Arrighi and Maume, , 07 (Barbara A. Arrighi, David J. Maume, 5/30/2007, Child Poverty in America Today: Health and Medical Care Volume II p. 108)

immigrants have visavis U.S. natives, at least at base-line or time of entry to the United States. is their relatively low prevalence of disease and disability. People who migrate tend to be healthy based on (e.g., travel. employment) and legal requirements of immigration (cg., health screening component of visa application). However, the health status of immigrants is likely to change with length of stay and each new generation born in the United Stares. Some immigrants may be able to attain higher health status during their stay in the United States due to the advanced
A potential advantage that American health-care system or their assimilation into the "health" culture of American society. For example, families may take advantage of availability of vaccinations and get children protected against disease. Other immigrants health may worsen in the course of assimilation because of the health risks embedded in the American culture (e.g,. fast food consumption. inactive lifestyles) or because of limited access to health-care.

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Status Quo=Deportation
Illegal immigrants get deported after visiting hospitals Zieger, Editor of Fierce health finance, 08
(Anne Zieger, Editor of Fierce health finance, 8-4-08, Trend: Hospitals deporting uninsured immigrants, http://www.fiercehealthcare.com/story/trend-hospitals-deporting-uninsured-immigrants/2008-08-04) When an American citizen with health insurance--either commercial or government-backed--is seriously injured or sick, hospitals receive meaningful reimbursement for their care, even if they don't get as much money they want. But when an uninsured illegal immigrant is seriously ill, hospitals may get nothing. And when the patient is ready for discharge, hospitals can seldom find a rehab facility or nursing home to provide follow-up care--which often means that the hospital, without an appropriate place for discharge, keeps patients for months or years as a ward. Nobody pays these million-dollar bills. That's the case, in part, because the government won't pay for care for illegal immigrants, temporary legal immigrants or legal residents with less than five years in the U.S. Lately, in response to these financial pressures, it's become more common to send such patients back to their home country, with or without their consent. Some patient families and attorneys call this patient dumping, but hospitals say they're just doing what they must to preserve their financial viability. While the practice isn't tremendously common, it does seem to be widespread, according to observers. No statistics exist on how often this happens, but it does appear that hospitals that see high volumes of illegal immigrants a year may engage in dozens of repatriations. The practice is so common that at least one repatriation company, California's MexCare, has emerged to serve these patients and help hospitals rid themselves of their burdens.

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More Immigrants Uninsured

Uninsured immigrants rates are skyrocketing Fronstin, Senior Research Associate Employee Benefit Research Institute, and MacDonald, 05
(Paul Fronstin, Bachelor of Science degree from SUNY Binghamton and his Ph.D. in economics from the University of Miami, 6-1305, Immigrants Make Up a Growing Share of U.S. Population Without Health Insurance, Study Finds, http://www.ebri.org/publications/prel/index.cfm?fa=prelDisp&content_id=3527)

Immigrants accounted for about one-third of the increase in the uninsured between 1994 and 1998, but between 1998 and 2003 they accounted for 86 percent of the increase, said Paul Fronstin, director of the EBRI Health Research and Education Program. To the degree that immigration continues to increase, it is likely that the uninsured will also continue to increase. The study, The Impact of Immigration on Health Insurance Coverage in the United
States, is published in the June EBRI Notes, and is available on the Internet at www.ebri.org. One factor that contributed to the increase in the uninsured immigrant population, the study says, is 1996 legislationknown as the Personal Responsibility and Work Opportunity Reconciliation Actwhich restricted most newly arrived legal immigrants from participating in health and other public programs for five years after they entered the country. Although these restrictions were subsequently loosened a bit, the study adds, the fact remains that fewer public benefits were available to recent immigrants during the latter part of the 1990s than earlier in the decade. And even after the five-year ban expired, immigrants may continue to be ineligible for public programs as a result of rules that attribute the income of an immigrants sponsor to the immigrant. For immigrants, the

likelihood of being uninsured increased from 1994 to 2003, the study says, while it barely changed for native-born Americans. In 1994, 34 percent of immigrants were uninsured, but by 2003 the number rose to 38 percent. In contrast, the uninsured rate among native-born Americans rose less than 1 percentage point from 14.1 percent in 1994 to 14.9 percent in 2003. The study makes these additional points: Immigrants are much more likely to be uninsured than citizens. Nearly 50 percent of foreign-born noncitizens were uninsured in 2003. That compares with 21 percent
uninsured among foreign-born individuals who have become U.S. citizens. Whether an immigrant is uninsured is highly correlated with the length of time he or she had been in the United States. Slightly more than 21 percent of foreign-born noncitizens who entered the United States before 1970 were uninsured in 2003. This compares with 43 percent uninsured foreign-born noncitizens who entered the United States during the 1980s, The majority of the uninsured foreign-born non-citizen population is comprised of recent immigrants. About one-third of uninsured non-citizens entered the United States during 2000-2004, while another 46 percent entered during the 1990s. In contrast, only about 3 percent of uninsured foreign-born naturalized citizens entered the United States during 20002004. About one-quarter entered during 1990-1999 and the remainder entered before 1990.

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AT: T PLIPs- Those Uninsured are poor

Immigrants without insurance earn low wages Goldman, Ph.D. in economics in Stanford, Smith, Ph.D. in economics, University of Chicago, Sood, M.A. in economics, Indiana University, 2005
(Dana P Goldman, Senior Principal Researcher @ RAND, Ph.D. in economics, Stanford University; B.A. in economics, Cornell University, Senior Economist; RAND Chair in Labor Markets and Demographic Studies, James P Smith, Education Ph.D. in economics, University of Chicago; B.S. in economics, Fordham University, Neeraj Sood, Economist, Ph.D. in policy analysis, RAND Graduate School; M.A. in economics, Indiana University; M.A. in economics, Delhi School of Economics Legal Status And Health Insurance Among Immigrants Health Affairs, Vol. 24, Iss. 6; pg. 1640, 14 pgs. Retrieved July 26, 2009, from ABI/INFORM Global. (Document ID: 930377541)

Evaluated over a two-year period, chronic uninsurance is far more common among the foreign-born and, within immigrants, five times more likely among the undocumented. But with the sole exception of the undocumented, virtually the entire higher rates of chronic uninsurance can be explained by factors other than their immigrant status. Much of the explanation lies in immigrants' lower SES levels-family income, education, assets, and working in industries less likely to offer health benefits. These SES markers and place of employment do a better job
explaining chronic than current insurance, most likely because of the transient nature of the latter. Consequently, our model leaves unexplained a small component of the lack of current health insurance. These SES measures and place of employment help explain a sizable part of the chronic (forty-four percentage points) and current (thirty-five percentage points) disparity among undocumented immigrants as well, but unexplained disparities remain for both. About 40 percent of the unexplained discrepancy for the undocumented is attributable to private insurance and the rest to public insurance. The unexplained disparities in public insurance rates are especially important for the undocumented. Whether real barriers to access, in the form of eligibility restrictions based on years of residency or perceived barriers by the immigrants themselves, exist is an area for more research

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Solvency
Utilizing social services to integrate immigrants de-marginalizes them
Arrighi and Maume, , 07 (Barbara A. Arrighi, David J. Maume, 5/30/2007, Child Poverty in America Today: Health and Medical Care Volume II p.130)

Social service agencies have often had to mediate between immigrants and U.S. institutions as newcomers learn to adapt to their new environments. In the process, the environment has begun to become sensitized to the diversity of the new arrivals. Less focus has been placed on the systematic understanding of the socioeconomic levels of these immigrant
groups and their implications for adaptation and achievement. Based on the allocation of immigration visas, there have been a variety of legal immigrant streams that have entered the United States in the last few decades. While earlier immigrants of the 1960s were, primarily of a professional stream, current streams are more likely to include large numbers entering throughout family reunification processes. These individuals and groups may not have the human capital and skills that are readily transferable into the fastpaced technological society. Consequently, the promised land of milk and honey may not be so for them. Two additional populations to the United States, refugees and undocumented immigrants, may find that they are frequently on the fringes of societythe former for a significant portion of their lives. and the latter, almost for their entire stay in the United States. Thus, a large segment of the immigrant group, particularly the newer immigrants of the last decade, is likely to be marginalized. Without the requisite English language competencies, education, and usable job skills, many hover at poverty levels.

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Repealing Section 434 of PRWORA is critical to letting immigrants access healthcare Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

The first, and most essential step of the recommendation process requires Congress to repeal Section 434 of the Welfare Reform Act and Section 642 of the Immigration Reform Law. This step is of vital importance because these sections have created an indirect roadblock for illegal immigrants accessing federally or state funded health care because they are not shielded from having their immigration status reported to the INS by health care officials. Repealing this legislation is the touchstone of providing illegal immigrants with undeterred publicly funded health care because if these sections remain in existence, states will not have the ability to provide illegal immigrants with security when they choose to access the available federally funded care and nor will states be effectively granted the power to provide illegal immigrants with preventive care. Congress should not have a problem repealing these sections because the [*586] objectives behind this legislation are unjustifiable. n123 Legislation proposing the reporting of immigration status of illegal immigrants when they attempt to access public, social services has a myriad of objectives. These objectives
include: First, illegal immigrants would be deterred from accessing public services if they fear being reported to the INS and subsequently deported. Second, with more information on persons believed to be in the United States illegally, the INS would be able to deport more persons. Third, as part of broader anti-immigration programs, the mandatory reporting schemes aim to deter the flow of illegal immigrants into the United States and encourage those already here to return to their home countries. Currently, there are approximately 8 million illegal immigrants in the United States. n125 In 1995, the federal government deported 1,200 illegal immigrants. n126 Even if these objectives were successful to the point where it increased the number of deportations by an overwhelming ten-fold to 12,000 deportations per year, this would still leave the majority of illegal immigrants in the United States. n127 If there is a significant increase in the number of deportations, the number will be nullified by the illegal immigrants that are bound to enter into the United States in the meantime. n128 In essence, these objectives are meaningless towards decreasing the number of illegal immigrants through

deportation. Even if the INS received a substantial increase in the names of illegal immigrants, history reveals that the INS is unlikely to apprehend and deport a number of illegal immigrants that would make any sort of significant impact. n129 Former New York City Mayor Rudolph Giuliani addressed the shortcomings of
this legislation that is supposedly intended to help the problem with illegal immigrants. n130 In New York City, there are approximately 2,500 undocumented illegal immigrants in their prisons. n131 Furthermore, nearly 4,000 illegal immigrants go through the New York City jail [*587] system every year. n132 Although the names of these illegal immigrants are handed over to the INS for deportation, the INS successfully deported merely 300 of these convicted felons. n133 Therefore, the INS already has a significant source of illegal immigrants they could deport but have chosen not to. "The Federal Government does not deport enough illegal aliens in any given year to put a dent in the illegal population." n134 Should legislation be aimed at deporting desperate, innocent illegal immigrants seeking health care, when the INS already has more than enough names of felon illegal immigrants to deport with their current funding? n135 The answer is no.

Instead of meeting the intended objective of deporting illegal immigrants, these sections only create a situation where poor, uninsured, illegal immigrants must fear going to public health care facilities and obtaining other essential social services. If this legislation is to be justified, deportation, not depriving these people from basic social services, must be the legitimate interest that the federal government is trying to accomplish. Creating indirect fear for illegal immigrants seeking much needed public health care services causes problems that are not justified by the federal government's modest number of deportations.

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Solvency
Federal action is key to allow immigrants access to preventive healthcare and to stop the spread of communicable diseases Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

Illegal immigrants, a growing, substantial portion of the United States population, face a wide range of challenges because of language, cultural, and financial barriers. Due to these barriers, they are often uninsured, impoverished, and encounter poor working and living conditions. Among these barriers is their inability to obtain reasonable access to publicly funded health care, even for emergencies and infectious diseases. Illegal immigrants are in this dilemma because federal legislation has fully stripped them of access to preventive care and created the possibility of deportation if they choose to access the available care for emergencies and communicable [*592] diseases. The same legislation also granted states the power to draft and pass affirmative legislation to provide illegal immigrants with state-funded, preventive health care. However, illegal immigrants must remain fearful of potential deportation if they choose to access it. Since illegal immigrants are deterred from obtaining state-funded health care, they are more likely to wait until their condition, whether infectious or not, is at an emergency level. Placing illegal immigrants in this insecure situation, where accessing publicly funded health care almost becomes a last resort, creates a myriad of problems not only for the illegal immigrant population, but for the general population as well. The general population, especially in crowded metropolises with a substantial number of illegal immigrants, is placed at a greater risk of becoming infected with communicable diseases. Health care officials are also left in confusion
regarding whether or not to report undocumented aliens, especially when they are untrained to act as INS agents. From an economic standpoint, indirectly forcing illegal immigrants to wait until their conditions are at emergency levels to seek treatment is inefficient because emergency care, which the government is required to provide, costs nearly four to tent times as much as providing preventive care. Another economic burden rests with the high cost of treating birth defects among children of illegal immigrants, who become United States citizen at birth. This cost could be avoided with proper prenatal care, but illegal immigrant mothers are either denied this service completely or are deterred from accessing it. Legislative

reform can help solve the numerous problems associated with illegal immigrants and their inability to access health care. Reform must start with the federal government by repealing legislation that bans state officials from preventing their state officials from sharing information with the INS. Next, states must utilize
this regained authority and pass limited cooperation ordinances in order to provide security for illegal immigrants that desire to access care. Finally, states should utilize their authority and pass legislation providing, at least, prenatal care and treatment for chronic and debilitating diseases. It should be duly noted that legislative reform is not going to be a "cure-all" for every problem associated with illegal immigrants and their ability to access and receive proper health care by any means. However, legislative reform would provide part of the solution to arguably the most important

problem regarding health care for the illegal immigrants, barriers to access.

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Solvency
Providing adequate access to healthcare will solve poverty Evans, MPH/DDS, 95
(Caswell A. Evans, director of the National Oral Health Initiative, 2-15-95, Annals of Internal Medicine Volume 122 Issue 4 | Pages 309-310)

One resounding feature of the health care system that many immigrants face is the lack of access to care of adequate quality. This lack of access, coupled with wide exposure to unhealthy U.S. lifestyles that are linked to costly chronic conditions [11], is a prescription for disaster, a prophecy already materializing in Los Angeles. The extent to which the health of recent immigrants declines over time reflects their risk for poverty, which, in turn, imposes ominous barriers to adequate health care. Improving access to health care and, in particular, to preventive health care, will substantially improve the health status of all those afflicted by poverty.

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Bioterrorism
Lack of Healthcare for Immigrants Bioterrorism Wynia and Gostin, University of Chicago Assistant Prof. and Georgetown Law Prof, 02
(Matthew K. Wynia is a Master of Public Health at the University of Chicago, Lawrence Gostin received his J.D. at Duke University and is currently the professor of law and public health at Johns Hopkins University, The Bioterrorist Threat and Access to Health Care, May 31st 2002, http://www.sciencemag.org/cgi/content/summary/296/5573/1613, [Abhik])

The intentional dispersal of anthrax spores in the United States demonstrates the need for preparedness for bioterrorism and naturally occurring infectious diseases capable of causing mass civilian casualties. In the event of a bioterror attack, medical-care professionals and institutions will be called on to help in the
rapid identification of health threats, to help prevent the spread of disease in the population, and to care for and treat infected patients. Many barriers to accomplishing these tasks, like improved training of health-care practitioners, funding for facilities improvements and pharmaceutical stockpiles, and coordination of information and reporting systems, are being explored and addressed (1). However, one additional issue might prove to be among the most formidable barriers to the effective handling of a bioterror attack in America. Recognizing the importance of early detection, the U.S. government has devoted considerable attention to expanding the national public health system's capacity to detect outbreaks (1). These detection systems rely largely on reports from the medical-care system; after all, persons with symptoms will likely present first in physicians' offices, clinics, or hospital emergency departments. But consider this: what if the first individual infected with a transmissible illness chooses not to be evaluated within the medical-care system? Such an individual's

illness, left undetected, might spread to family, neighbors, and other contacts. If these secondarily infected individuals also face barriers to care, the illness will spread further. In this way, a large-scale outbreak could be well under way before the medical community has an opportunity to make the first diagnosis. Once an outbreak occurs on a large scale, today's travel and work patterns could lead very rapidly to nationwide, or worldwide, dissemination. There are many potential reasons why an infected patient might
not present for evaluation by the medical-care system. Some, like individual stoicism and bravado in the face of illness, are less amenable to intervention by the medical-care system. However, more than 40 million U.S. citizens have no health insurance, a problem not faced by any other advanced industrialized nation. Their lack of insurance is a known risk to their own health (2), but it must now also be recognized as a risk to the nation's health (3). The Federal Welfare Reform Act of 1996 exacerbated the problem by virtually prohibiting federally funded medical clinics from providing most services to illegal immigrants (4). Publicity surrounding this law and its enforcement has been most damaging. For instance, although the act has specific exceptions for emergency treatment and for testing and treatment of symptoms of communicable diseases, Texas's state attorney general, John Cornyn, issued an opinion on 10 July 2001 stating that the Act precluded public clinics and hospitals in Texas from providing most services to illegal immigrants. An argument by Texas's public hospitals that early entry into the health-care system is cost-effective and necessary to protect the public's health did not sway the state from pursuing a strict interpretation of the Act. Indeed, before September 11, a lawsuit against the hospitals was being considered [(5), the suit is now "in limbo" (6)]. Adding to these concerns may be immigrants' and health-care professionals' memories of California's Proposition 187, which called on practitioners to refuse to treat illegal immigrants and to report them to immigration authorities (7). Passed in 1994, this proposition was never fully implemented and its health-care provisions were turned back in 1999 during mediation by the Settlement Program of the 9th Circuit Court of Appeals, but it has undoubtedly contributed to mistrust of the medical-care system among immigrants (8). In the aftermath of the attacks on the World Trade Center buildings, attempts have been made locally to remove barriers to access. The Governor of New York issued Executive Orders 113 and 54, declaring a state disaster and, in the words of New York's Health Commissioner Antonio Novello, ordering medical-care providers, "Thou shalt not ask who will pay for this" before providing care for potential victims of the attacks (9). Over the next 4 months, New York's Disaster Relief Medicaid program enrolled almost 400,000 people (10). Doing so involved obtaining additional funding from the state pool for the uninsured and a dramatic streamlining of the application process for Medicaid (9). In our view, a similar lowering of barriers to access is in order for everyone living

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Bioterrorism
within U.S. borders. In particular, two steps should be taken immediately to facilitate detection and reporting of
infectious diseases. First, a homeland defense directive should go out, stating that individuals with symptoms that suggest infection with a contagious illness should present for evaluation and that those who do so will be treated without prejudice. Second, patients and physicians should be assured that no adverse consequences will result from reports to public health departments. An effective national defense against bioterrorism requires that all potentially infected patients can be at least evaluated without fear of deportation or other significant social or economic losses. Although additional funds will be required to evaluate uninsured patients, the investment in detection is the right thing to do--and it might even save money in the long run, as treatable and preventable illnesses are detected

earlier and contained.

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Bioterrorism
Lack of Healthcare for Immigrants Bioterrorism Wynia and Gostin, University of Chicago Assistant Prof. and Georgetown Law Prof, 04
(Matthew K. Wynia is a Master of Public Health at the University of Chicago, Lawrence Gostin received his J.D. at Duke University and is currently the professor of law and public health at Johns Hopkins University , Ethical Challenges in Preparing for Bioterrorism: Barriers Within the Health Care System, July 2004, http://www.ajph.org/cgi/content/full/94/7/1096#BDY [Abhik]) In the area of patient access to health care, more challenging dilemmas arise. Strong ethical reasons have long been recognized as supporting universal access to a decent minimal set of health care services,19yet our nation has been unable or unwilling to accomplish this.20 Perhaps if policymakers understand that inadequate access to care poses a threat to national security, progress can be made.21,22 In the United States, more than 40 million Americans lack health insurance, and this number is rising.23,24 Although some uninsured individuals use emergency rooms to obtain care when they are acutely ill, many of the uninsured and underinsured avoid the health care system for as long as possible.20 Some

have argued that bioterror-related illnesses are so severe that anyone affected would surely seek care.25 But uninsured patients discriminate poorly between appropriate and inappropriate care and tend to avoid both equally.26 Numerous studies demonstrate that the uninsured are more likely to present in an advanced stage of illness, and many die without ever being evaluated.2729Terrorists undoubtedly recognize that even a small-scale release of an infectious agent into a community with a high rate of un insurance might be devastatingly effective. Because most of the uninsured are employed and working throughout cities, suburbs, and rural areas, starting an outbreak in such a community using a low-tech approach, such as an infected "martyr"would reduce the likelihood of early detection and raise the odds of broad spread of the disease.30 Unfortunately, this scenario is not mere speculation: "natural experiments" that simulate such an attack have demonstrated the vulnerability of poor, especially uninsured immigrant, populations and their ability to spread disease throughout the population.31,32 Many naturally occurring infectious diseases, including tuberculosis, food-borne illnesses, and HIV/AIDS, disproportionately burden the uninsured and subsequently spread to the community at large.33Maintaining barriers to accessing health care in the face of todays threats should be unacceptable, morally and
politically. In the aftermath of the September 11 attacks, New York ordered its health care system to provide care to all possible victims 34 and the state health commissioner, Antonio Coello Novello, declared to providers: "Thou shalt not ask who will pay for this."35 Over the next 4 months, New Yorks special Disaster Relief Medicaid program enrolled and cared for almost 400 000 people.36 New York dramatically streamlined the application process for Medicaid and obtained additional funding for the state pool for the uninsured. The public, government, and the medical community widely approved these actions as appropriate, given the threat. 37,38 Learning from this experience, federal and state

officials should make clear that individuals with symptoms that suggest infection with a contagious illness should present for evaluation and ensure that those who do can be treated without prejudice.
Funding must be provided to cover screening and treatment of patients with contagious illnesses; in particular, funding for hospital emergency departments that see large volumes of uninsured patients must be increased. 39 Because patients cannot be expected to know in advance whether their illness is infectious, programs can be targeted toward contagious illness but ultimately, they will need to be broad based. Finally, funding alone might not guarantee ready access to care for

certain populations, especially recent immigrants and those who mistrust the health care system.22 The current policy focus on addressing racial and ethnic health disparities should be used to build a culturally sensitive primary care system in which all patients feel welcome.

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Illegal immigrants risk bioterrorism LeMay, prof of Environmental Science @ CSU, 06

(Michael Lemay is Professor, and chair of Environmental Science at California State University, San Bernardino, 12-21-06, Illegal Immigration pg. 112) The world is increasingly becoming "a global village." As the worldwide economy becomes more intermingled, the flow of migration becomes ever more massive (200 million plus) and nearly uncontrollable. Illegal immigrants flow from

impoverished Third World countries and economies to those of the First World, often transitioning through oilier "stepping-stone" nations. Nearly every developed nation grapples with legalization programs and controversies over how best to control illegal immigration. The global refugee issue amounts to an enormous pool of potential illegal migration and taxes the best efforts of receiving states to develop effective and comprehensive border management policy. The unprecedented worldwide flow of migration portends the danger of epidemic diseases becoming pandemics threatening the lives of millions worldwide. Illegal immigration exacerbates the problem and has become increasingly linked in the developed nations to policies aimed at protection against both natural disease outbreaks and bioterrorism. The complex economics that drive illegal immigration render single-nation efforts in domestic policy to control
the low ineffectual. The developed nations of the world, as illegal immigration receiving states, increasingly rely on multinational and regional approaches to cope with the problem.

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Immigrants put US at risk of bioterror attack Green, PhD, 04

(Shane K. Green, PhD, Director of Outreach at Ontario Genomics Institute, 5-4-04 American Medical Association Journal of Ethics Volume 6 Number 5, http://virtualmentor.ama-assn.org/2004/05/pfor2-0405.html)

A nation's greatest defense against bioterrorism, both in preparation for and in response to an attack, is a population in which an introduced biological agent cannot get a foothold, ie, healthy people with easy access to health care. Yet, in spite of spending significantly more per capita on health care than any other developed nation, the US is peppered with communities in which many people have little or no access to health care . This may be due to a lack of adequate health insurancea fact
of life for over 43 million demographically diverse Americansor to cultural barriers that inhibit proper utilization of available services, or to inadequate distribution of health professionals and services. These communities are more vulnerable to infectious diseases [4] and therefore might be considered the nation's Achilles' heal in a bioterrorism attack . Take, for example, vaccination. A lack of access to health care among US citizens, particularly immigrant populations and

those living in poverty, is associated with a failure to be vaccinated. This can have a serious impact on the spread of contagion, as evidenced by a rubella outbreak in 1997 in Westchester County, New York, in which a readily containable virus
managed to infect a community composed largely of immigrants who had not been immunized [5]. Granted, US federal law permits all persons, including immigrants living here illegally, to receive emergency health care, immunizations and treatment of communicable diseases; those who are unable to pay can receive these services through Medicaid. Studies have shown, however, that immigrants are often disinclined to apply for Medicaid for fear that doing so will compromise their residency status or citizenship applications [6]. Still others avoid the health care system altogether due to mistrust or language barriers [7]. Yet , the stockpiling of

"prophylactic countermeasures" remains the focus of many current preparedness initiatives, including Project BioShield [8]. The national stockpile of smallpox vaccine, for example, has been expanded in the wake of the 2001 terrorist attacks to a point where it now contains sufficient quantities to vaccinate the entire US population, in the event that the threat of smallpox is deemed imminent [9]. If effectively disseminatedthrough mass vaccination programs, for examplethe vaccines would indeed constitute a significant line of defense against smallpox; however, it would be a line unwittingly breached by persons unable to be vaccinated. Since this is true of any and all such stockpiles, barriers to access must be addressed if these initiatives are to effectively mitigate the harmful effects of any bioterrorist attack. Immunization, however, is not the whole story; though comprehensive vaccination programs may help to
defend against select agents like smallpox, it is simply impractical to suggest that all Americans could, in anticipation of such an attack, be given vaccines and subsequent boosters, if necessary, for each and every pathogen that could be used as a weapon

especially since a bioweapon would quite possibly contain an engineered strain of a pathogen for which no satisfactory vaccine exists. If such an attack were to take place, it would be imperative for infected individuals to seek immediate medical attention. This is especially true for index cases, the identification and isolation of which is essential to limit the spread of contagion (if the agent used is transmissible person to person). Early identification of index cases enables health officials to trace contacts and swiftly report potential cases, thereby allowing early measuressuch as isolation or quarantineto halt, or at least slow, an emerging potential epidemic [10]. A lack of access would greatly impede such an early and effective response, turning vulnerable citizens into unwitting facilitators for the spread of infectious disease. Indeed, it has been shown that people without health insurance report up to 47 percent fewer visits to physicians
[11], and often wait longer to seek medical attention even when doing so would be prudent, eventually presenting in advanced stages of infection. Almost certainly, once an incident of bioterrorism has been identified and news of it has permeated the

media, all potentially exposed persons, insured and uninsured alike, would report to health care facilities for assessment. But by then it might be too late to prevent the outbreak from devastating entire communities especially since recent data suggest that to prevent new viral epidemics, infected patients must be identified and isolated at the earliest possible stages of an outbreak to avoid the virus reaching peak infectivity [12].

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Bioterrorism causes extinction- outweighs nuclear war Steinbruner, Director of CISSM, 97

(John D. Stienbruner, Professor of Public Policy at the School of Public Policy at the University of Maryland and Director of the Center for International and Security Studies at Maryland For. Pol. No, 109, Winter 1997-1998)

Although human pathogens are often lumped with nuclear explosives and lethal chemicals as potential weapons of mass destruction, there is an obvious, fundamentally important difference: Pathogens are alive, weapons are not. Nuclear and chemical weapons do not reproduce themselves and do not independently engage in adaptive behavior; pathogens do both of these things. That deceptively simple observation has immense implications. The use of a
manufactured weapon is a singular event. Most of the damage occurs immediately. The after effects, whatever they may be, decay rapidly over time and distance in a reasonably predictable manner. Even before a nuclear warhead is detonated, for instance,

it is possible to estimate the extent of the subsequent damage and the likely level of radioactive fallout. Such predictability is an essential component for tactical military planning. The use of a pathogen, by contrast, is an extended process whose scope and timing cannot be precisely controlled. For most potential biological agents, the predominant drawback is that they would not act swiftly or decisively enough to be an effective weapon. But for a few pathogens ones most likely to have a decisive effect and therefore the ones most likely to be contemplated for deliberately hostile usethe risk runs in the other direction. A lethal pathogen that could efficiently spread from one victim to another would be capable of initiating an intensifying cascade of disease that might ultimately threaten the entire world population. The 1918 influenza epidemic demonstrated the potential for a global contagion of this sort but not
necessarily its outer limit.

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Bioterrorism can collapse the ecosystem

Meyerson, asst. prof @ Univ of Rhode Island for Science, and Reaser, PhD, 03 (Laura A. Meyerson, Assistant Professor of Natural Resources Science at the University of Rhode Island, Jaime K. Reaser, PhD at Stanford, August 2003, Bioinvasions, bioterrorism, and biosecurity, Frontiers in Ecology and the Environment, Vol. 1, No. 6, pp. 307-314. ) Based on the above description, foreign agents used in bioterrorism are by definition invasive alien species. While the IAS released with intent to cause harm have so far been limited to microbes (to the best of our knowledge), any organism that causes direct or indirect harm to humans could become a terrorist tool. Vectors of human disease, from mosquitoes to migratory birds, may be of particular concern (Figure 2). However, harmful impacts (more subtle but cumulative) could also

occur if terrorists chose to introduce organisms that damage infrastructure or compete with or prey upon native plants, wildlife, or domestic stock. Serious consideration of biosecurity in this broader perspective will highlight many
challenges, not least of which is that the overwhelming majority of attention and resources are devoted to military threats, while nonmilitary threats are often ignored. The following section provides examples of IAS that are already placing US biosecurity at risk by causing substantial and chronic damage, as well as scenarios that illustrate how IAS could be used as bioterrorist tools. Although numerous sectors have been and could be affected by IAS, we place particular emphasis on human health, agriculture, infrastructure, and the environment. The consequences of invasion are likely to be most readily apparent in these sectors, resulting in economic losses due to declines in commerce and the provision of natural goods and services. A brief discussion of IAS issues relevant to biosecurity in the US follows, with recommendations for the next steps towards building a comprehensive approach to biosecurity. Human health Due to increases in the rate, scale, and modes of transportation, a disease outbreak anywhere in the world can quickly become an international or global problem (CDC 2002). A recent example is the SARS epidemic (Figure 3) which spread to at least 30 countries in a matter of weeks and as of June 2003 was just contained in China. Many infectious diseases, including HIV/AIDS, have been introduced into the US and elsewhere by travelers and imports such as exotic food or animals. Invasive vectors already established in the US are spreading invasive pathogens (see www.promedmail.org, the global electronic reporting system for infectious diseases and toxins run by the International Society for Infectious Diseases). Several introduced mosquito species are competent vectors for West Nile virus (WNV) (Andreadis et al. 2001; Lounibos 2002). While human fatalities resulting from WNV infections have thus far been relatively limited (254 as of this writing; see www.cdc.gov for updates), the disease has spread across the US in only 3 years from the site of introduction in New York City, and poses a serious threat to the North American blood supply (Couzin 2003). Reactions by the public and officials to this biological invasion have so far been measured, but it is interesting to consider how the national response to a rapid invasion by this virus might escalate if it were established that WNV had been intentionally introduced as a bioterrorist agent. The introduction pathways and rates of spread of pathogens such as WNV illustrate how migratory birds and other animals could be used as vectors for bioweapon introductions aimed either at wildlife, livestock, or humans. Agriculture The potential impact of intentionally introduced pathogens (eg foot-and-mouth disease or karnal bunt) on American livestock and agriculture is enormous, given that total US sales in beef, pork, and dairy products reach approximately $74 billion annually, and the US annual wheat production half of which is exported is valued at approximately $6 billion (NRC 2002; Wheelis et al. 2002). Even without acts of terrorism, IAS costs the agricultural sector tens of billions of dollars every year by reducing crop yields through plant and animal disease management, pesticide applications (Pimentel et al. 2000), and colonization of pasturelands. Infrastructure In most cases the effects of IAS on infrastructure are not immediate, but instead are more subtle and cumulative (Figure 4). In the case of bioterrorism, impacts on infrastructure would most probably occur as indirect consequences of IAS introduction. Nonetheless, damage to infrastructure by IAS is a chronic and costly problem. For example, in the US and Canada, zebra mussels (Dreissena polymorpha) colonize and clog the water intake pipes of power plants, navigational locks, and other parts of the aquatic-based infrastructure (Bright 1998). Nuclear power plants are particularly vulnerable to zebra mussel fouling, since disruption of the cooling system can be a safety hazard. Zebra mussels are thought to infest at least 12 North American power plants, with yearly control costs exceeding $800 000 per plant (ONeill 1997). Wildlife and ecosystems IAS can alter the structure and function of environmental systems at all levels of organization, from genes to ecosystems (Levin 1988; McNeely et al. 2001; Sanders et al. 2003) and have impacted at least half of the species listed as threatened or endangered in the US (Wilcove et al. 1998). IAS are now among the top drivers of environmental change globally (Mooney and Hobbs 2000; Sala et al. 2000). This makes IAS introductions one of the most important current issues for natural resource managers and conservation scientists (NISC 2001). Although wildlife and ecosystems are not usually considered terrorist targets, an intentional

assault could have profound consequences for native species, with spillover effects to humans, crops, and livestock (Daszak et al. 2000; Dudley and Woodford 2002; Meyerson and Reaser 2002a). An intentionally or unintentionally introduced wildlife pathogen, such as the zoonotic bacterium Brucellosis, could spread to livestock, necessitating the

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slaughter of both wild and domestic animals (Daszak et al. 2000; NADC 2002; Figure 5). Some endangered species could face local extirpation, and perhaps extinction, as a result of control measures, if they exist in only a few relict populations and prove to be reservoirs for biological weapons such as plague and tularemia (Dudley and Woodford 2002). A terrorist attack on the environment would have economic consequences (eg losses in tourism), but the greater impact
might be on the national psyche, if, for example, a national park and/or highly charismatic wildlife species were targeted.

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Bioterrorism
Giving Healthcare to immigrants and alleviating the fear of deportation is key to stopping a bioterror attack Medical News Today 2004
(Medical News Today, 8-31-2004, Minorities worry public health system won't respond fairly in a bioterrorist event, http://www.medicalnewstoday.com/articles/12670.php) Finally, the 1996 Personal Responsibility and Work Opportunity Reconciliation Act aims to restrict immigrants' access to public health services. While generally not followed by state and local health authorities, the act requires the

reporting of undocumented immigrants who seek medical assistance. The UCLA study was based on interviews
with 8,167 participants who answered 120 core questions. A random sample of 1,041 participants answered 12 additional questions about terrorism . According to the paper, public health officials can alleviate this perceived unfairness to minority

groups by including their representatives in bioterrorism-response planning, and urging community participation during the response. It may also be necessary to address provisions of welfare and immigration laws in order to design and implement an effective response to a bioterrorist attack, the study says. "Improving perceptions that public health agencies will respond fairly to bioterrorism events will additionally enhance their capacity to deal with emerging natural disease outbreaks," the study says.

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Bioterror Outweighs
Bioterror poses the greatest WMD threat OToole, CEO and Director of the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC), and Inglesby, Chief Operating Officer and Deputy Director of the Center for Biosecurity of UPMC, 09
(Tara OToole, MD MPH Professor of Medicine and of Public Health at the University of Pittsburgh, Thomas Inglesby, MD Associate Professor of Medicine and Public Health at the University of Pittsburgh Schools of Medicine and Public Health, March 2009, Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science Volume 7, Number 1, pgs 25-28, copyright Mary Ann Liebert- publisher of authoritative peer-reviewed journals)

exists confusion in parts of the executive branch, in Congress, and in state governments about the importance and urgency of the bioterrorism threat. This confusion exists in spite of a decade-long litany of government assessments, reports by prestigious commissions, and independent analyses that have been quite clear on these issues. Taken together, these reports conclude that there are no technical barriers that prevent state programs, nonstate groups, or individuals from building and using a biological weapon that could sicken or kill as many as tens of thousands of people or more, and that could lead to grave societal disruption and economic damage. The National Intelligence Council, writing on behalf of the entire intelligence community, has said that biological weapons pose the greatest WMD threat to the country. The effectiveness of biological weapons was demonstrated by a number of state bioweapons programs in the 1960s and 1970s (including the U.S. program that was then terminated by President Nixon), which tested bioweapons on a large scale. In the nearly 40 years since, biotechnology has become more global, more accessible, and more powerful. We are in the midst of a biotechnology revolution driven by an explosion of knowledge and technologies, global capital markets, and powerful information technology tools.
There

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Congress Action Key to Bioterror

States cant solve bioterror OToole, CEO and Director of the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC), and Inglesby, Chief Operating Officer and Deputy Director of the Center for Biosecurity of UPMC, 09
(Tara OToole, MD MPH Professor of Medicine and of Public Health at the University of Pittsburgh, Thomas Inglesby, MD Associate Professor of Medicine and Public Health at the University of Pittsburgh Schools of Medicine and Public Health, March 2009, Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science Volume 7, Number 1, pgs 25-28, copyright Mary Ann Liebert- publisher of authoritative peer-reviewed journals)

Ensuring that Americans have access to the medicines and vaccines they need after a bioattack or a naturally
occurring epidemic will require substantial long-term commitment, funding, coordination of federal programs, and better partnerships with academia and industry. A well-informed and engaged Congress is critical to the success of this work. This will require

substantial gains in the capacity to rapidly and less expensively make vaccines and medicines for established biological threats as well as for threats that might arise from nature or be deliberately engineered as weapons. Such progress would position the country to make enormous, unprecedented contributions to global health. In 1940,
FDR called the U.S. the arsenal of democracy. The Obama Administration has the opportunity to propel this work forward in a way that could enable the U.S. to serve as a global arsenal of public health.

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Disease Adv.
Early testing is key to stop the spread of communicable diseases. Immigrant access Healthcare access is key to detection Kullgren, Clinical Fellow at Harvard Med School, 03
(Jeffery T. Kulgren, M.D., MPH, Clinical Fellow in Medicine at Harvard Medical School, October 2003, American Journal of Public Health Vol. 93 No. 10, http://www.ajph.org/cgi/reprint/93/10/1630)

consequences of undocumented immigrants health burdens and barriers to accessing services extend beyond the individual to the entire community. The agricultural and food service settings in which many undocumented immigrants work, for example, can facilitate the spread of communicable diseases to other segments of the population. 6 Johns and Varkoutas also suggest that fear of detection has driven undocumented immigrants to pursue treatments through underground channels, which may have helped fuel the emergence of drug-resistant microbes.8For the most part, PRWORAs limitations on the provision of health services to undocumented immigrants have not been
The embraced by state and local officials. In light of the threats that undocumented immigrants health conditions pose to communities, relatively few local jurisdictions have established policies explicitly limiting provision of health services based on immigration status.9 Many publicly supported health care institutions in Texas, for example, have long provided free and discounted nonemergency care to all residents, even after the enactment of welfare reform legislation.10 There are, however, a few notable exceptions to this trend, including institutions in San Diego, Albuquerque, and Fort Worth.9,11 In response to the ambiguity generated by this seemingly pervasive disconnection between policy and practice, administrators of the Harris County Hospital District, which includes the city of Houston and constitutes the third-busiest public health care system in the United States, sought guidance from Texas Attorney General John Cornyn in late 2000 to ascertain whether its proposed payment policy revisions (which would have permitted the district to provide free or discounted care to anyone who could show county residency and financial need) violated PRWORA and to determine the possible penalties for any such violations.12 Attorney General Cornyns subsequent opinion concluded that the welfare reform law prohibits the district from providing free or discounted nonemergency health care to undocumented immigrants, even if they reside within the districts boundaries, and that no state laws enacted since 1996 expressly state the legislatures intent that undocumented aliens are to be eligible for certain public benefits.13 With respect to potential penalties, the attorney general decided that, while PRWORA does not explicitly describe a penalty for providing public benefits to undocumented immigrants, there may be sanctions to the district pursuant to conditions attached to federal funding and that there may also be legal consequences pursuant to state law for spending public funds for an unauthorized purpose.13 Cornyns opinion has stirred an intense debate both in Texas and around the nation. Some of the states local advocates and district attorneys have pressed for public inquiries into the activities of jurisdictions that choose to continue to provide free and discounted services; in Harris County, the local district attorney initiated a criminal investigation of the hospital district and its leadership.14 Fearful of similar investigations in their own jurisdictions, some health care institutions in Nueces County, which includes Corpus Christi, and Montgomery County, just outside of Houston, have chosen to limit the services provided to undocumented individuals rather than leave their organizations and administrators exposed to prosecution. 9,10 Other parties that support hospitals long-standing policies have obtained alternative legal interpretations of applicable state and federal laws that they claim justify the continued provision of discounted services to all residents irrespective of immigration status.15 While Harris Countys district attorney has withdrawn his criminal investigation in an effort to achieve a workable compromise with health administrators, and calls for the initiation of similar inquiries around the state appear to have subsided, Attorney General Cornyns opinion still stands to shape public health policy regarding undocumented immigrants not only in Texas but across the country.16 Attorneys general and local prosecutors in other jurisdictions may draw on the opinion to initiate legal action against institutions that provide discounted services irrespective of immigration status. Should a court uphold Cornyns opinion and related legal challenges, institutions that have not amended their policies to accommodate PRWORAs restrictions may face increased scrutiny. Institutions in states such as California and New York, which have relatively large undocumented populations but so far appear to have been spared from legal inquiries, could conceivably be the next targets. Even if other jurisdictions policies are not contested in court, the Cornyn opinion itself may have a chilling effect by discouraging undocumented immigrants from accessing health care as well as discouraging individual institutions from providing discounted services to undocumented populations. HOW THE RESTRICTIONS JEOPARDIZE PUBLIC HEALTH The divergent reactions to Cornyns opinion, the differing responses of health care providers, and the absence of definitive guidance from any level of government leave many publicly supported institutions in a state of legal and administrative uncertainty. The public health community should recognize, call attention to, and press for resolution of the threats posed to community health and welfare by this uncertainty

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these restrictions fail to consider the power and responsibility of state and local governments, and the institutions they fund, to protect the health, safety, and welfare of all who reside within the states borders. While regulation of immigration has traditionally been a federal
responsibility, Gostin notes that part of the constitutional compact of our Union was that states would remain free to govern within the traditional sphere of health, safety, and morals.17(p48) Indeed, PRWORAs restrictions on the provision of health care infringe on states police power and limit their ability to protect the health of their residents .17,18 Second, prohibiting the provision of discounted health care endangers access to services among undocumented immigrants children, many of whom are born in the United States and are therefore eligible for publicly funded health care programs.19 Findings of the Kaiser Commission on Medicaid and the Uninsured suggest that immigrants are often confused by state and federal eligibility restrictions and are intimidated by the threat of being discovered and deported.20 As a result, even though PRWORA allows for provision of discounted immunizations and emergency servicesand children born in the United States are eligible for government funded health coveragefear of immigration authorities or beliefs that their children do not qualify for services may prevent undocumented parents from seeking health care for their native-born children. A similar argument that improving adults access to services will improve childrens access to carehas been offered as a rationale for expanding public health insurance coverage to parents of children enrolled in state Childrens Health Insurance programs.21 Third, PRWORAs restrictions on the provision of health care services contradict the longstanding ethical obligations of clinicians by requiring providers to assume responsibilities traditionally reserved for federal immigration officials.5,18 Ziv and Lo note that physicians who comply with mandates to deny services to undocumented immigrants forgo the ethical ideal that patients medical needs should be attended to without regard to their social, political, or citizenship status. 22(p1097) In addition, while PRWORA does not place as great a burden on health professionals as Proposition 187, the ballot initiative that sought to deny many public services to undocumented immigrants and require clinicians to report undocumented individuals to the Immigration and Naturalization Service, a legislative order to deny services leaves the door open for further, more invasive intrusions on the confidentiality that facilitates trust between patients and providers. Fourth, the administrative complexities generated by limits on the provision of services by publicly supported health care providers endanger access to care among legal residents. Guidelines issued by the US Department of Justice require that all patients be treated equally; therefore, all patients should be required to provide evidence of their immigration status.9 Sorting through immigration documents for each patient, and turning away those who lack sufficient documentation but are unable to pay for the full cost of services, would increase administrative costs and waiting times, reducing the efficiency of already overburdened safety-net institutions.2 Fifth, restricting access to preventive services while requiring institutions to continue to provide care for emergency conditions prevents administrators from putting public resources to their most cost-effective use. Laws such as the Emergency Medical Treatment and Labor Act require institutions to provide expensive acute health care to undocumented individuals when they present with emergency medical conditions.6,23 In many cases, such as management of diabetes, asthma, or hypertension, preventive care can thwart the need for costly services to treat conditions that have progressed to emergency status.24 Providing prenatal care to undocumented mothers has also been shown to be cost-effective.25,26 Prohibiting the provision of these services prevents administrators from managing taxpayers resources in the most cost-effective manner and may ultimately limit the health care safety nets ability to finance both public health and individual medical services. Finally, limiting undocumented immigrants

access to health services weakens efforts to fight the spread of communicable diseases among the general population. While PRWORAs exemptions include the treatment of infectious diseases and their symptoms, conditions such as tuberculosis are not always easily detected as communicable diseases. 8 In addition, many cases of infectious disease are identified not when symptoms manifest themselves but when patients seek medical care for other unrelated conditions.24 Consequently, identifying and treating communicable diseases in their earliest stages requires that undocumented immigrants be able to access services for all health conditions not just those that have progressed to an emergency level or include symptoms of infectious diseasebefore others in the community are exposed.

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PRWORA currently restricts Medicaid for immigrants- half a million of who carry communicable diseases Kullgren, Clinical Fellow at Harvard Med School, 03
(Jeffery T. Kulgren, M.D., MPH, Clinical Fellow in Medicine at Harvard Medical School, October 2003, American Journal of Public Health Vol. 93 No. 10, http://www.ajph.org/cgi/reprint/93/10/1630)

Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 greatly restricts the provision of many federal, state, and local publicly funded services to undocumented immigrants. Many public health and health
care institutions have wrestled with the legal, administrative, and ethical conflicts generated by these limitations. The debate has been most visible in the state of Texas, where the legality of several public hospitals provision of free primary and preventive health care to undocumented immigrants has been challenged. Instead of serving their intended purpose of reducing illegal immigration and conserving public resources, PRWORAs restrictions on undocumented immigrants access to publicly financed health services unduly burden health care providers and threaten the health of the community at large. These deleterious effects warrant the public health communitys support of strategies to both repeal these restrictions and sustain the provision of health services irrespective of immigration status. INTENT AND SUBSTANCE OF PRWORAS RESTRICTIONS The enactment of PRWORA in 1996 went further than simply ending welfare as we knew it. The law also broke significant new ground in immigration policy by declaring that current eligibility rules for public assistance and unenforceable financial support agreements have proved wholly incapable of assuring that individual aliens not burden the public benefits system and that it is a compelling government interest to remove the incentive for illegal immigration provided by the availability of public benefits. 1 To these ends, the law outlines standards in regard to legal and undocumented immigrants eligibility forand the provision ofservices supported by the federal government and by state and local governments. With respect to state and local public benefits, PRWORA declares that undocumented immigrants are ineligible for any retirement, welfare, health, disability . . . or any other similar benefit

for which payments or assistance are provided to an individual, household, or family eligibility unit by an agency of a State or local government or by appropriated funds of a State or local government .1 Exceptions include
assistance for health care items and services that are necessary for the treatment of an emergency medical condition and public health assistance for immunizations with respect to immunizable diseases and for testing and treatment of symptoms of communicable diseases whether or not such symptoms are caused by a communicable disease.1 PRWORA also allows provision of public benefits to undocumented immigrants if states enacted legislation after August 22, 1996, that affirmatively provides for such eligibility or if the US attorney general declares additional services exempt from the laws restrictions.1 UNDOCUMENTED IMMIGRANTS HEALTH AND ACCESS TO SERVICES The 300000 to 500000 undocumented immigrants that enter the United States

each year arrive bearing a disproportionate burden of undiagnosed illness including communicable diseases such as tuberculosis and HIV and frequently lack basic preventive care and immunizations.25

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Immigrants lacking healthcare risk TB spread IDSA 08

(Infectious Diseases Society of America, October 29, 2008, http://www.idsociety.org/Content.aspx?id=12146) A new study raises the question, do barriers to health care for undocumented immigrants increase the public health risk of tuberculosis? The study, published in the November 15, 2008 issue of Clinical Infectious Diseases and now available online, suggests that undocumented immigrants with tuberculosis have symptoms longer before seeking care than documented immigrants or U.S.-born patients, resulting in more severe symptoms and more opportunities for transmission. These findings raise questions about the value to both patients and the public of improving access to health care for undocumented immigrants . Rates of tuberculosis are declining overall in the United States, but the proportion occurring among foreign-

born persons is increasing and the case rate is almost 10 times higher than that among persons born in the United States. Furthermore, funding for tuberculosis elimination is declining, leading to concerns about a resurgence of the disease. In a review of medical records for patients diagnosed with pulmonary tuberculosis at a New York City hospital between
April 1999 and March 2005, the authors of this study investigated whether there were any differences in clinical presentation among U.S.-born, foreign-born and documented, or foreign-born and undocumented individuals. Of 194 patients with newly diagnosed pulmonary tuberculosis, 31 percent were U.S.-born, 32 percent were foreign-born and documented, and 37 percent were foreign-born and undocumented. Undocumented patients exhibited an increased frequency of cough, bloody expectoration, and a much longer duration of symptoms prior to hospitalization compared to U.S.-born patients.

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Immigrants will go to doctors, increasing number of cases to solve diseases Wynia and Gostin, Masters of public health and prof of law, 02
(Matthew K. Wynia is a Master of Public Health at the University of Chicago, Lawrence Gostin received his J.D. at Duke University and is currently the professor of law and public health at Johns Hopkins University, The Bioterrorist Threat and Access to Health Care, May 31st 2002, http://www.sciencemag.org/cgi/content/summary/296/5573/1613,) The intentional dispersal of anthrax spores in the United States demonstrates the need for preparedness for bioterrorism and naturally occurring infectious diseases capable of causing mass civilian casualties. In the event of a bioterror attack, medical-care professionals and institutions will be called on to help in the rapid identification of health threats, to help prevent the spread of disease in the population, and to care for and treat infected patients. Many barriers
to accomplishing these tasks, like improved training of health-care practitioners, funding for facilities improvements and pharmaceutical stockpiles, and coordination of information and reporting systems, are being explored and addressed (1). However, one additional issue might prove to be among the most formidable barriers to the effective handling of a bioterror attack in America. Recognizing the

importance of early detection, the U.S. government has devoted considerable attention to expanding the national public health system's capacity to detect outbreaks (1). These detection systems rely largely on reports from the medical-care system; after all, persons with symptoms will likely present first in physicians' offices, clinics, or hospital emergency departments. But consider this: what if the first individual infected with a transmissible illness chooses not to be evaluated within the medical-care system? Such an individual's illness, left undetected, might spread to family, neighbors, and other contacts. If these secondarily infected individuals also face barriers to care, the illness will spread further. In this way, a large-scale outbreak could be well under way before the medical community has an opportunity to make the first diagnosis . Once an outbreak
occurs on a large scale, today's travel and work patterns could lead very rapidly to nationwide, or worldwide, dissemination. There are many potential reasons why an infected patient might not present for evaluation by the medical-care system. Some, like individual stoicism and bravado in the face of illness, are less amenable to intervention by the medical-care system. However, more than 40 million U.S. citizens have no health insurance, a problem not faced by any other advanced industrialized nation. Their lack of insurance is a known risk to their own health (2), but it must now also be recognized as a risk to the nation's health (3). The Federal Welfare Reform Act of 1996 exacerbated the problem by virtually prohibiting federally funded medical clinics from providing most services to illegal immigrants (4). Publicity surrounding this law and its enforcement has been most damaging. For instance, although the act has specific exceptions for emergency treatment and for testing and treatment of symptoms of communicable diseases, Texas's state attorney general, John Cornyn, issued an opinion on 10 July 2001 stating that the Act precluded public clinics and hospitals in Texas from providing most services to illegal immigrants. An argument by Texas's public hospitals that early entry into the health-care system is cost-effective and necessary to protect the public's health did not sway the state from pursuing a strict interpretation of the Act. Indeed, before September 11, a lawsuit against the hospitals was being considered [(5), the suit is now "in limbo" (6)]. Adding to these concerns may be immigrants' and health-care professionals' memories of California's Proposition 187, which called on practitioners to refuse to treat illegal immigrants and to report them to immigration authorities (7). Passed in 1994, this proposition was never fully implemented and its health-care provisions were turned back in 1999 during mediation by the Settlement Program of the 9th Circuit Court of Appeals, but it has undoubtedly contributed to mistrust of the medical-care system among immigrants (8). In the aftermath of the attacks on the World Trade Center buildings, attempts have been made locally to remove barriers to access. The Governor of New York issued Executive Orders 113 and 54, declaring a state disaster and, in the words of New York's Health Commissioner Antonio Novello, ordering medical-care providers, "Thou shalt not ask who will

pay for this" before providing care for potential victims of the attacks (9). Over the next 4 months, New York's Disaster Relief Medicaid program enrolled almost 400,000 people (10). Doing so involved obtaining additional
funding from the state pool for the uninsured and a dramatic streamlining of the application process for Medicaid (9). In our view, a similar lowering of barriers to access is in order for everyone living within U.S. borders. In particular, two steps should be taken immediately to facilitate detection and reporting of infectious diseases. First, a homeland defense directive should go out, stating that individuals with symptoms that suggest infection with a contagious illness should present for evaluation and that those who do so will be treated without prejudice.
Second, patients and physicians should be assured that no adverse consequences will result from reports to public health departments. An

effective national defense against bioterrorism requires that all potentially infected patients can be at least evaluated without fear of deportation or other significant social or economic losses. Although additional funds will be required to evaluate uninsured patients, the investment in detection is the right thing to do--and it might even save money in the long run, as treatable and preventable illnesses are detected earlier and contained.

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High levels of TB directly correlate with the increase of immigration empirically proven Kenyon, MD and MPH, 99 (Thomas Kenyon, MD and MPH, from the Epidemic Intelligence Service, 7-1-99,
http://pediatrics.aappublications.org/cgi/content/full/104/1/e8)

The increase in tuberculosis among children on the United States-Mexico border may be largely attributable to transmission outside of the United States in countries in which tuberculosis is highly endemic, as well as within the United States from household contacts born in those countries. In contrast to the national trend of increased cases among those born in countries in which tuberculosis is highly endemic, the greatest increase in San Diego County was observed among young children born in the United States. Over 90% of tuberculosis cases among US-born children younger than 5 years had a parent or source case from a country in which tuberculosis is highly endemic, a history of foreign travel, or a primary household language other than English. These findings may help
explain national trends in which only 15% of tuberculosis cases in children younger than 5 years are foreign-born, compared with 35% of cases in children 5 years or older.1 Tuberculosis surveillance systems in the United States do not monitor routinely the birthplace of parents or source cases of children and probably are underestimating the contribution of the global tuberculosis epidemic to US-born children in this country. The findings of this investigation in San Diego County support the recommendation that children who are from or who have parents who are from regions of the world with a high prevalence of tuberculosis are at high risk and should be screened for tuberculous infection.11 However, the findings also indicate that screening of children in this population should occur earlier than the currently recommended 4- to 6-years of age.11 Because most of the very young children with tuberculosis were <4-years old when diagnosed with tuberculosis, screening at the recommended ages in this setting would not have identified the majority of young children with tuberculosis. The evidence that only 54% of source cases were known to be parents also supports the recommendation of screening children who have a circle of close contacts (eg, other relatives, caretakers, family friends, and neighbors) that includes persons from regions of the world with a high prevalence of tuberculosis regardless of their relationship to the child. The increase in tuberculosis among children in San Diego County coincided with similar increases in immigration into California. After

the Immigration Reform and Control Act of 1986, the number of immigrants into California increased by 334%
from 168 790 in 1986 to a peak of 732 735 in 1991.13 The Immigration Reform and Control Act provided for immigration of undocumented aliens who had been resident in the United States since 1982 and for seasonal agricultural workers who had been resident during 1985 through 1986. Children younger than 15 years are not required to be screened for tuberculosis during immigration unless known to be contacts to a tuberculosis case. Each year, >3 million nonimmigrant visitors also come to California, but their contribution to transmission would be difficult to document.13 Nearly half of children younger than 5 years were known to have traveled to visit family in Mexico, suggesting that cross-border contact may have also contributed to transmission in addition to immigration into the United States. Since 1993, tuberculosis cases in children have decreased nationwide. This is also true for San Diego County in which cases decreased from 75 cases in 1993 to 45 cases in 1997. The largest decrease occurred in those children younger than 5 years in which there was a 70% decrease in the number of cases between 1993 and 1997. Health department investigation of children with tuberculosis in San Diego County demonstrated that they came from a household environment in which nearly 70% of contacts had evidence of tuberculous infection. This was particularly true if the child, parent, or source case was foreign-born. Identification and investigation of these tuberculosis households should be an effective strategy for case finding and identification of potential candidates for preventive therapy. However, the challenges to investigations of tuberculosis on the border by the health department were demonstrated by the relatively low proportion (8.8%) of tuberculosis cases in children identified as a result of contact investigation, the low proportion (14.5%) of cases in whom a source case was identified, and the high proportion (35.7%) of instances in which the child with tuberculosis was identified before the source case was diagnosed as having tuberculosis. To help

improve tuberculosis control in the United States, cross-border cooperation and collaboration toward tuberculosis control should continue to be promoted and encouraged by public health officials in neighboring communities on both sides of the United States-Mexico border.

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Afraid immigrants delay turning to healthcare exposing TB to several Houston Journal of International Law, 97 (Houston Journal of International Law, Spring of 1997,
http://www.entrepreneur.com/tradejournals/article/19741669_6.html)

Tuberculosis is one of the contagious diseases that may increase because of policies deterring patients from seeking care.(201) Some health care professional contend that such anti-immigrant measures would increase the number of tuberculosis cases.(202) They conducted a study to see if patients with tuberculosis delay seeking care because of fear
of immigration authorities.(203) The results of their study revealed that twenty percent of the tuberculosis patients in the study lacked legal residency documents.(204) Six percent of the symptomatic patients reported that fear of immigration authorities had delayed their care.(205) "More than 47% of those who cited fear of immigration authorities delayed more than 60 days .... Respondents who feared immigration authorities were almost four times as likely ... to delay seeking care."(206) The researchers found that the tuberculosis patients may have exposed themselves to an average of ten contracts during their delay in seeking care.(207) Most of the patients did not know of their tuberculosis infection until they sought care for one of the symptoms. (208) The study concluded by saying: "If future research confirms our findings, any policies that increase

undocumented immigrants' fear that health care professionals will report them to immigration authorities may exacerbate the current tuberculosis epidemic."(209) Even if anti-immigrant legislation allowed for emergency care for illegal aliens, this would not alleviate the problem.(210) Any increase in the fear of immigration authorities that patients experience when seeking medical care is likely to increase the delay between onset of symptoms and first contact with the medical care system. Because each patient possibly exposes an average of ten contacts to the disease during the course of delaying care, such an increase would spread tuberculosis beyond those who delay.(211) Health officials in consensus immigrants must have access to healthcare to prevent spread Houston Journal of International Law, 97 (Houston Journal of International Law, Spring of 1997,
http://www.entrepreneur.com/tradejournals/article/19741669_6.html)

Physicians and health officials have concluded that one way to attack the tuberculosis epidemic and other disease in the United States is to lower the barriers to health care for immigrants.(215) Prevention is the key to reducing the spread of contagious diseases such as tuberculosis.(216) Illegal aliens must have access to health care so that they may be screened for communicable diseases and treated. In the long run treatment for illegal aliens, will be costeffective because it will actually halt the spread of disease to others.(217) Spending dollars now to prevent the spread of disease will cost less than treating patients in the future.(218) Providing healthcare to illegal immigrants is better in the long run 2 reasons Houston Journal of International Law, 97 (Houston Journal of International Law, Spring of 1997,
http://www.entrepreneur.com/tradejournals/article/19741669_6.html) Immigrants have high rates of contagious diseases, and "[c]ontagious

diseases ... do not check for immigration status."(257) These disease will spread to many others, including citizens, if immigrants are not provided adequate treatment.
Expenditures on emergency health care and health care for citizen-children will similarly increase without preventive care for illegal immigrants. Ultimately , the protection of the health of all persons living in the United States and a decrease in health

care expenditures can be attained by providing health care to illegal immigrants. In the long run, ignoring illegal immigrants' health needs actually fosters the spread of preventable diseases and exacerbates the economic burdens created by public health care needs.

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One disease, three epidemics Malin, department of political sciences, 2-23 (Adam Malin, department of political sciences at the London School of
Hygiene and Topical Medicines, 2-23-09, http://thorax.bmj.com/cgi/reprint/50/Suppl_1/S37) THE FIRST EPIDEMIC: A GLOBAL RESURGENCE

The world faces three epidemics from tuberculosis. The first of these is the re-emergence of tuberculosis itself.
Before 1985 the industrialised world had experienced a steady decline in tuberculosis.'2 There had also been some success of tuberculosis control in the developing world with a decline in incidence in some countries and a stabilisation in others,3 albeit often at an unsatisfactory level. Overall, the pattern of events looked promising. Funding for control programmes in affluent countries was reduced, research interest waned, and it was believed that, like smallpox, this disease could be eventually eradicated.2 However, the disease has returned with a ven- geance. In 1992 the World Health Organisation ( WHO)

declared tuberculosis a "global emergency". It estimated that 1-7 billion people were latently infected with Mycobacterium tuberculosis (approximately one third of the world's population), with an annual toll of eight million new cases of active disease and 2-9 million deaths. Thus, tuberculosis represents the single biggest killer of all the infectious diseases and accounts for 26% of avoidable adult deaths in the developing world. THE SECOND EPIDEMIC: HIV AND TUBERCULOSIS Co-infection with HIV and tuberculosis is a "cruel duet", each exacerbating the other and resulting in a tuberculosis into the non-HIV infected population.4 This second epidemic of HIV-related
tuberculosis has been termed the "new tuberculosis"5 and bears only a resemblance to its older sibling. The major differences are shown in the box. For example, pulmonary disease may present with non-specific features including radio- graphic bilateral lower zone shadowing, a loss of predilection for the upper lobes, and absence of cavities. Extrapulmonary tuberculosis, particularly disseminated disease, is more frequent. The age of presentation has shifted away from those previously most at risk - the very young and elderly - to young adults who account for those most economically productive. Of all the risk factors for the development of tuberculosis, HIV is by far the most potent with a relative risk of 6-100 when Impact of HIV on tuberculosis Increase in reactivation of old latent infection Increase in reinfection and recurrent disease following treatment Loss of disease control in poor communities Change in the clinical picture (increase in extrapulmonary and disseminated disease) Change in age of presentation (increase in young adults) compared with HIV negative individuals.6 Not surprisingly, Africa is experiencing a major resurgence in tuberculosis, mainly as a consequence of the overlap between high levels of latent tuberculosis infection and a very high level of HIV infection, 20-67% of tuberculosis patients being co-infected with HIV.7 In one large nec- roscopic study in Abidjan, Cote d'Ivoire, tuberculosis was found in over 50% of cadavers with AIDS-defining pathology.8 Particularly worrying is the fact that only one tenth of the world's tuberculosis infected population reside in Africa; a further billion live in Asia and the western Pacific. As HIV spreads into these countries, the potential outcome is devastating. THE THIRD EPIDEMIC: MULTIDRUG RESISTANCE The third epidemic is in our midst - namely, multidrug-resistant tuberculosis. To date, the brunt of the epidemic has been confined to the USA,9-'3 but the conditions that gave rise to multidrug-resistant tuberculosis exist throughout the world and we would be wise to learn from their experience. Of the US cities affected, New York has been particularly badly hit. This picture is well exemplified in the introductory article - a hospital-based study by Neville and colleagues in which cases of drugresistant tuberculosis seen at the Chest Service at Belle- vue Hospital, New York are described.'4 They reviewed 20 years of tuberculosis laboratory susceptibility tests in 4681 cases and observed a striking increase in multi-drug-resistant tuberculosis. Combined resistance to iso- niazid and rifampicin rose from 2-5% in 1971 to 16% in 1991. Of those 16%, over three quarters were resistant to four standard agents - rifampicin, isoniazid, streptomycin, and ethambutol. The clinical notes of 100 patients with drug-resistant tuberculosis were reviewed and compared with 54 randomly selected drug-sensitive tuberculosis patients. Demographic characteristics of both the drug-sensitive and drug-resistant groups were similar. Most of the patients belonged to

one or more of the following groups: young (under 40 years), Black or Hispanic, unemployed, homeless, male, HIV-infected, or drug misuser. Clinical characteristics were also compared between drug-sensitive and drug-resistant groups.
These features included: anergy, fever, cough, night sweats, weight loss, radiograph bilateral infiltrates, adenopathy, cavities, miliary shadowing, and normal chest radiograph. Only anergy appeared to be significantly more common in the drug-resistant group than the drug-sensitive group (33% versus 8%; p<005).out HIV have a 50% treatment failure rate within 18-24 months.9 22 Whilst most cases of multidrug-resistant tuberculosis have occurred throughout North America, evidence exists to suggest that rifampicin resistance may be in- creasing in Thailand and Tanzania.23 Moreover, significant drug resistance has been reported in West and Central Africa, with more than 30% primary resistance to isoniazid.23 Drug resistance to isoniazid in East Africa before HIV was stable at 7% for over 30 years. Data from a cohort in Kenya show no evidence of a subsequent increase.

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TBXTN
XDR-TB causes extinction Student News Daily, 07
Student News Daily, Human Catastrophe World Magainze, 5/29/2007 The high death rate from XDR led doctors and journalists to call it "virtually untreatable." But Farmer, the physician whose life story is recounted in Tracy Kidder's book Mountains Beyond Mountains (Random House, 2003), says it's not too late to treat XDR. Patients who died in South Africa received only standard treatment for drug-sensitive TB. By the time test results confirmed that they had XDR-TB, all but one of the patients had died. In March, Partners In Health announced it had received a $3 million grant from the Open Society Institute to develop a treatment model for XDR. It will start its work in Lesotho, a landlocked country within the borders of South Africa. That same month the CDC released a report stating that there were 49 cases of XDR in the United States from 1993 to 2006. The report said the United States and global health organizations could target XDR by gathering more information about its incidence, prevalence, and causes. WHO's Stop TB coordinator, Paul Nunn, in February called on nations to immediately fund the $650 million needed annually to combat drug-resistant TB with the Global Plan. "If these resources are not found," Nunn told convention-goers in Geneva, "we face, over the next few years, the replacement of the current global epidemic of mostly drug-susceptible TB, with multi- or extensively drug-resistant disease, and the need to solve a human catastrophe, at vastly greater expense than if we address it now with all the skills and dedication of which we are actually capable."

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TB growing
XDR-TB is growing Medical News 09
Medical News, 3/23/2009, Drug Resistant Tuberculosis is increasing among U.S. immigrant population, <http://www.news-medical.net/news/2009/03/23/47191.aspx> According to the AP/Google.com, the increase in drug-resistant TB comes as funding for TB programs in cities such as San Francisco, which has the highest TB rates nationwide, is being reduced, prompting concern among TB researchers. Immigrants living in states such as California are particularly vulnerable to drug-resistant TB because many people frequently travel to countries with higher TB prevalence -- such as China, India or Mexico -- or were born in such countries. California recorded 2,696 TB cases in 2008 and 451 cases of drug-resistant TB between 1993 and 2007. About 83% of drug-resistant cases recorded in the state involved foreign-born immigrants, the AP/Google.com reports (Barbassa, AP/Google.com, 3/22). According to CDC, TB incidence in California was about seven cases per 100,000 people in 2008, compared with 4.2 cases per 100,000 people nationwide during the same year (Lin, Los Angeles Times, 3/22). In addition, a statewide analysis of drug-resistant TB cases between 1993 and 2006 found that the proportion of patients who could develop extensively drug-resistant TB increased from 7% to 33%. XDR-TB is resistant to two of the most potent first-line treatments and at least two of the classes of second-line drugs. "California, having so much exposure to the world via immigration and travel, is particularly at risk," Gil Chavez, deputy director of the California Department of Public Health, said. Jennifer Grinsdale, program manager and epidemiologist with the TB control section of the San Francisco Department of Public Health, said recent budget cuts have hindered the city's ability to administer TB tests proactively to diagnose and treat latent TB cases in high-risk areas. "Anywhere from two to 10 years from now, we'll see the impact for this," Grinsdale said (AP/Google.com, 3/22).

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TB growing
Immigrants bring in TB Charatan, staffwriter for BMJ, 2K
Fred Charatan, staffwriter for BMJ, US alarmed over rise in Tuberculosis among immigrants, < http://www.bmj.com/cgi/content/full/320/7228/140/d> With tuberculosis surging in developing countries and immigration to the United States from those countries at a record high, public health officials are alarmed at the rising incidence of pulmonary tuberculosis among immigrants. In 1998, immigrants, who accounted for only 10% of the population, accounted for nearly 42% of the 18 371 cases of tuberculosis reported throughout the United States. The Centers for Disease Control and Prevention said that from 1986 to 1997 the number of tuberculosis cases among people born outside the United States increased by 56%, from 4925 cases (22% of the national total) to 7702 cases (39% of the national total). Most cases among those born abroad, it said, are likely to be the result of reactivation of remotely acquired infection, although some transmission is probably occurring in the United States. The increase in tuberculosis cases among those born outside the United States over the past decade is attributed partly to increased immigration, peaking in 1986 when the law was eased, allowing amnesty for illegal immigrants already in the country. Another factor is increased immigration from Asia and Latin America, where tuberculosis rates are 5-20 times higher than in the United States.

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Immigrants Swine Flu

Lack of Healthcare for Immigrants Swine Flu Alonso-Zaldivar, Staff Writer Boston Globe, 5-4
(Ricardo Alonso-zaldivar, staff writer for the Boston Globe, Swine Flu could shine glaring light on uninsured, May 5 th 2009, http://www.ajc.com/services/content/health/stories/2009/05/05/uninsured_flu.html?cxtype=rss&cxsvc=7&cxcat=9 [Abhik])

Swine flu could shine a glaring light on the best and worst about American-style health care. At top labs, scientists are optimistic they can make a vaccine thats effective against the new virus. But in a country where one in seven people lack medical insurance, doctors worry that some individuals wont get needed protection because of cost. It could leave the rest of society more vulnerable. In a flu epidemic, the uninsured face the worst options: flooding the emergency
rooms or self-medicating with cold preparations and hoping for the best. Many might not be aware they can also go to a federallyfunded community health center and see a doctor or nurse for little or no cost. Helping the estimated 50 million uninsured will mean more than just paying for their health care. For example, if theyre here as illegal immigrants, should taxpayers still cover the costs?

Public health experts say obstacles to getting medical attention are counterproductive if youre trying to stop an infectious disease in a highly mobile society like the United States. The person Im most worried about is the one who decides to delay getting care, and does it in such a way that they infect others or put themselves at greater risk, said Dr. Georges Benjamin, executive director of the American Public Health Association. To have an epidemic with millions of people who may not go to the doctor because they cant afford to pay remains one of the unique challenges of our system. Lawmakers are already proposing fixes. The big health care overhaul Congress is working on probably
wont be ready if a bad flu strikes later this year. Sen. Dick Durbin, D-Ill., and Rep. Lois Capps, D-Calif., have introduced legislation to pay for temporary medical treatment for uninsured people during a public health emergency. It could be a natural disaster

such as an earthquake or hurricane, a bioterror attack, or a medical emergency such as a flu pandemic. We cant afford to have barriers that keep people from getting care when an epidemic is sweeping the community, Capps
said. Separately, Sen. Tom Harkin, D-Iowa, has proposed to offer all individuals a free flu shot each year. The Obama administration has not taken a position on either bill. But it has started shipping anti-flu medicines to community health centers, which provide basic medical care to the uninsured. Trust for Americas Health, a public health group that has focused on pandemic flu preparedness, is supporting the Durbin-Capps bill. During a public health emergency, the federal government would step in and take care of the needs of the people who are affected by that emergency , said Jeff Levi, executive director of the group. Health care providers would not be left holding the bag for people who are uninsured. It will be a win for individuals because theyll be able to get the care they need. Many details of the legislation are still being worked out. Government coverage would be limited to treatment for problems that are related to the public emergency. Dealing with immigrants could be one of the most difficult issues. The uninsured are mostly native born. But immigrants are more than twice as likely to be uninsured as people born here. When Congress was under Republican control it sharply restricted safety net benefits for immigrants, even legal ones. The Democratic-controlled Congress reversed that trend for legal immigrants when it expanded health insurance earlier this year for children in low-income families. It would be another issue to cover illegal immigrants, even if

only for a short time. But since Mexico is the epicenter of the outbreak, some experts say that may be prudent. We dont want to have a policy that drives people underground, Benjamin said. Its better to have them present for care so that they dont put anybody else at risk.

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Lack of Healthcare for Immigrants Swine Flu CBS, 4-28

(CBS, National News Network, Illegal Immigration and the Spread of Swine Flu, April 28th 2009, http://www.cbs8.com/Global/story.asp?S=10267847 [Abhik])

Health officials are concerned about the spread of swine flu from Mexico to the U.S. by illegal immigrants. Migrants in San Diego may not have access to medical care, which could lead to the spread of the virus within those communities. San Diego State University public health professor Thomas Novotny says county health officials should be surveilling local migrant camps for signs of swine flu and offer treatment to them if possible. "The treatment is not
exactly perfect with this. It requires seeing a medical provider and paying for an expensive drug with 24 to 48 hours, so it's not an easy fix," Novotny said. Novotny, who worked for more than 20 years with the Centers for Disease Control and Prevention, says there

is potential for major spread of the virus within the region's migrant settlements. "When they're concentrated in groups and some of them are sick and not able to isolate themselves, the potential for a spread is significant," he said. Novotny says those who are working and living illegally in the U.S. must be the targets of a major outreach campaign. "The main thing to do as much public education as possible... bilingual reaching those who have least access to medical care Here in San Diego, Mexican Consul General Remedios Gomez Arnau is in close contact with community leaders to make sure they are telling migrant workers and visiting Mexican nationals about the swine flu. " It's very important to reach out to everyone, because the virus doesn't distinguish between migrant and non-migrant," Arnau said. Because
of the outbreak, Arnau is also giving consulate employees the option of wearing protective masks during their contacts with clients. "If we see someone sneezing or coughing, we advise them to wear the mask we provide to them. So far we haven't had anyone who apparently could be sick," she said

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Tuberculosis is re-emerging more resistant in poverty-stricken communities Morens, Folkers, and Fauci, National Institute of Allergy and Diseases, Health, Health and Human Services, 4 (David
Morens, Gregory Folkers, Anthony Fauci, National Institute of Allergy and Diseases, Health, Health and Human Services, 7-04, http://www.nature.com/nature/journal/v430/n6996/pdf/nature02759.pdf)

Tuberculosis is one of the most deadly re-emerging diseases (Fig. 2).The discovery of isoniazid and other drugs
initially led to effective tuberculosis cures, empty sanitoria and the dismantling of public health control systems in developed nations. Consequently, by the 1980s, when tuberculosis had re-emerged in the era of HIV/AIDS,

local and state health departments in the United States lacked field, laboratory and clinical staff and so had to reinvent tuberculosis control programmes25. The remarkable re-emergence of tuberculosis was fuelled by the immune deficiencies of people with AIDS, which greatly increases the risk of latent Mycobacterium tuberculosis infections progressing to active disease, and being transmitted to others . Inadequate courses of anti-tuberculosis therapy compound the problem, leading to the emergence and spread of drugresistant and multidrug-resistant strains60, and a need for more expensive treatment strategies such as directly observed therapy. It has been known for over a century that tuberculosis is a disease of poverty, associatedwith crowding and inadequate hygiene. The continuing expansion of global populations living in poverty makes tuberculosis more difficult to control.

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Now that Tuberculosis is multi-drug resistant, TB is a pandemic that will continue to kill millions Zumla, Center for Infectious Diseases, 99 (A. Zumla, The Journal of Infection 1999,

1-19-99, http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WJT-4BYT0RC4J&_user=4257664&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=964813677&_rerunOrigin=sch olar.google&_acct=C000022698&_version=1&_urlVersion=0&_userid=4257664&md5=de142349d0d5ea763662380ef5bae5d5) By the 198Os, the incidence of tuberculosis in the developed world was very low and. consequently clinical and research interest was diverted away from this disease to other health issues. At the same time, however, it was becoming clear that the long awaited eradication of this disease was not imminent. The previous decline in incidence of the disease in

many developed nations was leveling off, more cases were being described in immigrant and ethnic minority communities within these nations, very little decline in the high incidence in the developing world was occurring and there were the first hints that the emerging HIV/AIDS pandemic might have a devastating
effect on the epidemiology of the disease. Accordingly, on March 24th 1992. the centenary of Kochs discovery, the World Health Organization decreed that this day, and all subsequent anniversaries, would be designated World TB Day. Sadly, the alarm bells were not sounded loudly enough and it was not until the early 1990s when it became abundantly

clear that New York City was in the grip of a serious outbreak of tuberculosis, i with many cases being multidrug resistant, that strong demands for action were made. In fact, so strong was the clamour for action that, in 199 3. the World Health Organization took the unprecedented step of declaring tuberculosis a Global Emergency.4 Despite this call for action, the exact scale of the global emergency is not easily determined. Notification of cases is notoriously unreliable, even in developed nations with good reporting
systems and statutory notification. In 1994, 3.3 million cases of tuberculosis were notified worldwide but these probably account for no more than a third of all cases. Estimates on the prevalence of tuberculosis have therefore been based on the use of the tuberculin test to demonstrate infection by the tubercle bacillus and the known rate of development of active disease among positive reactors. On this basis it has been calculated that about one-third of the human

population, around 2000 million people. has been infected by the tubercle bacillus., Although most of those who are infected display no signs of disease. the bacilli may persist in an unknown state and give rise to active disease years or decades later - so-called endogenous reactivation. In addition. and contrary to long
held dogma, the use of DNA fingerprinting has shown that active disease may also be due to recent exogenous reinfection of previously infected persons.; Once infected, a person is at risk of developing active tuberculosis at

some time during the remainder of their lives. As a broad generalization, about 5% of nonimmunocompromized infected persons develop such disease within 5 years of infection (primary tuberculosis) and 5% develop it subsequently (post-primary tuberculosis), i.e. a total of l0%. As described below, the
risk of overt disease is much higher among those who are HIV-positive. Key Points. Among infectious diseases, tuberculosis is the worlds leading cause of death. l One-third of the worlds population has been infected by the tubercle bacillus. l Each year, over 8 million people develop active tuberculosis and almost 3 million die. . The HIV pandemic has had a devastating impact on tuberculosis control programs, leading to an expected additional 1 million cases in 1999. l The treatment for tuberculosis is among the most effective and cost-effective of all cures for life-threatening diseases. . Further basic science and operational research is required to achieve better treatment rates and control measures. The actual number of people from the infected pool developing active tuberculosis each year was estimated by the World Health Organization to be 7.5 million in 1990 and 8.8 million in 1995. It has also been calculated that this number could show a 3 7% increase from the 1990 estimation to 10.2 million by the year 2000. Using slightly different methods for estimating the incidence, it was calculated that 7.3 million new cases occurred in 1997. The geographical distribution of the new cases of tuberculosis in 199 7 is shown in Figure 1. As tuberculosis is a chronic disease and only a minority of patients worldwide have access to effective medical services. the prevalence of cases of active tuberculosis is much higher than the incidence of new cases and may approach 16 million. with about half of them having infectious forms of pulmonary tuberculosis. The number of persons infected by one of these infectious patients is affected by many factors but, overall, around 100 million are added to the infected pool each year . The burden of tuberculosis falls principally on the developing nations where 95% of cases, and 98% of deaths due to the disease occur. It causes around 3 million deaths annually, mostly of young adults but also of at least 100 000 children under the age of 5

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By causing one-third of all deaths, infectious diseases are the commonest cause of mortality in the world today and, among these diseases, tuberculosis is the single most important cause of adult death. It kills more adults than AIDS, malaria, and other tropical diseases together, being responsible for 7% of all adult deaths and 26% of preventable adult deaths, despite the fact that the treatment is among the most effective, and cost-effective of all interventions for life-threatening conditions. The World Health Organization has calculated that, unless effective control measures are rapidly and widely deployed, the annual number of deaths due to tuberculosis could rise to 4 million by the year 2004.

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These new strains are rising problems in the US as these strains are now very deadly Markel, MD and PhD, 7(Howard Markel, MD and PhD from the University of Michigan Medical School, 7-4-07, http://jama.amaassn.org/cgi/content/full/298/1/83) Media coverage of Speaker's situation provided many people with an introduction to XDR-TB, which is the latest chapter in humanity's battle with the "white plague." Once thought under control in developed countries, TB cases increased

in the 1980s after funding cuts for TB prevention and treatment programs and the emergence of the AIDS pandemic. The reemergence of TB had the harshest consequences in the developing world,
particularly with the impact of HIV/AIDS on susceptibility to TB infection. The increase in TB cases led to an increase in inadequate or incomplete antibiotic treatments, which produced resistant TB strains.7 Multidrug-resistant TB (MDR-TB) arose during this period and includes TB strains that are resistant to at least 2 of the most commonly prescribed anti-TB drugs: isoniazid and rifampin. MDR-TB often appears when a patient takes an incomplete course of anti-TB medications or is acquired during exposure to air shared with other persons harboring MDR-TB, if infection control precautions are not implemented or are inadequate. But XDR-TB is more

problematic because it is also resistant to any fluoroquinolone and at least 1 of the 3 second-line drugs: capreomycin, kanamycin, and amikacin.8
Surveillance data on XDR-TB are still rudimentary, but even with incomplete information, public health officials are alarmed. XDR-TB has appeared in many countries, including the United States, and is of particular concern in Eastern Europe, South Africa, and Asia.9 The issuance in 2006 by the World Health Organization (WHO) of a global alert about XDR-TB10 underscores the harsh reality that XDR-TB has the potential to transform

a once treatable infection into an infectious disease as deadly, if not more so, than TB at the beginning of the 20th century. Unchecked diseases spread by immigrants causes extinction Steinbruner, Director of CISSM, 97
(John D. Stienbruner, Professor of Public Policy at the School of Public Policy at the University of Maryland and Director of the Center for International and Security Studies at Maryland For. Pol. No, 109, Winter 1997-1998) It is a considerable comfort and undoubtedly a key to our survival that, so far, the main lines of defense against this threat have not depended on explicit policies or organized efforts. In the long course of evolution, the human body has developed physical barriers and a biochemical immune system whose sophistication and effectiveness exceed anything we could design or as yet even fully understand. But evolution is a sword that cuts both ways: New diseases emerge, while old diseases mutate and adapt. Throughout history, there have been epidemics during which human immunity has broken down on an epic scal e. An infectious agent believed to have been the plague bacterium killed an estimated 20 mil lion people over a four-year period in the fourteenth century, including nearly one-quarter of Western Europe's population at the time. Since its recognized appearance in 1981, some 20 variations of the HIV virus have infected an estimated 29.4 million worldwide, with 1.5 million people currently dying of AIDS each year. Malaria, tuberculosis, and cholera once thought to be under controlare now making a

comeback. As we enter the twenty-first century, changing conditions have enhanced the potential for widespread contagion. The rapid growth rate of the total world population, the unprecedented reedom of movement across international borders, and scientific advances that expand the capability for the deliberate manipulation of pathogens are all cause for worry that the problem might be greater in the future than it has ever been in the past. The threat of infectious pathogens is not just an issue of public health, but a fundamental security problem for the species as a whole

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Moral Obligation
Giving Healthcare to immigrants is our moral obligation Kullgren, Clinical Fellow at Harvard Med School, 03
(Jeffery T. Kulgren, M.D., MPH, Clinical Fellow in Medicine at Harvard Medical School, October 2003, American Journal of Public Health Vol. 93 No. 10, http://www.ajph.org/cgi/reprint/93/10/1630)

Third, PRWORAs restrictions on the provision of health care services contradict the longstanding ethical obligations of clinicians by requiring providers to assume responsibilities traditionally reserved for federal immigration officials.5,18 Ziv and Lo note that physicians who comply with mandates to deny services to undocumented immigrants forgo the ethical ideal that patients medical needs should be attended to without regard to their social, political, or citizenship status. 22(p1097) In addition, while PRWORA does not place as great a burden on health professionals as Proposition 187, the ballot initiative that sought to deny many public services to undocumented immigrants and require clinicians to report undocumented individuals to the Immigration and Naturalization Service, a legislative order to deny services leaves the door open for further, more invasive intrusions on the confidentiality that facilitates trust between patients and providers . Fourth, the
administrative complexities generated by limits on the provision of services by publicly supported health care providers endanger access to care among legal residents. Guidelines issued by the US Department of Justice require that all patients be treated equally; therefore, all patients should be required to provide evidence of their immigration status.9 Sorting through immigration documents for each patient, and turning away those who lack sufficient documentation but are unable to pay for the full cost of services, would increase administrative costs and waiting times, reducing the efficiency of already overburdened safety-net institutions.

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Security 1AC
We propose the following plan: The United States federal government should repeal section 434 of the Personal Responsibility and Work Opportunity Act and Section 642 of the Immigration Reform Law.

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The advantage is otherization Immigrants refuse to participate in health care because of hierarchal service Derose et al. Ph.D. in health services, 07
(Kathryn Pitkin Derose, Ph.D. in health services, University of California, Los Angeles; M.P.H. in population and family health, University of California, Los Angeles; B.A. in comparative area studies-Latin America, Duke University, Nicole Lurie, MD, MSPH, is the Director of the RAND Center for Population Health and Health Disparities and Co-Director of the RAND Center for Domestic and International Health Security. She is also a Senior Natural Scientist and the Paul O'Neill Alcoa Professor of Health Policy at RAND, Prof. Nicole Lurie is senior natural scientist and Paul O'Neil Alcoa Professor of Policy Analysis at RAND. She is also Associate Director for Public Health at the RAND Center for Domestic and International Health Security, 2007, Health Affairs, 26, no. 5 (2007): 1258-1268, http://content.healthaffairs.org/cgi/content/full/26/5/1258) Stigma and marginalization. Immigrants vulnerability can also be influenced by factors related to stigma and marginalization. A variety of factors can contribute to this: differences in appearance (for example, wearing traditional dress), cultural and religious practices, language barriers, speaking with an accent (even among immigrants who speak English), and skin tone. Stigmatization of immigrant populations can be exacerbated by community concerns regarding the effects of immigration on community resources. A common theme in newspaper articles and opinion pieces of late is that immigrants, especially the undocumented, overburden the safety net and take away from "deserving" families, even though research suggests that immigrants in general and the undocumented in particular use relatively little health care.30 Being part of a stigmatized group can make immigrants reluctant to seek care because of concerns about poor treatment. If providers do not have adequate resources to serve immigrant groups, longer waits and frustration affect both patients and providers. As noted earlier, immigrants and those with limited English proficiency are generally less satisfied with their care than U.S.-born or English-speaking populations. Further, immigrants are more likely than U.S.-born populations to report discrimination in health care.31 Perceptions of being discriminated against can reinforce feelings of stigmatization and lead to decreased use of health services in the future. PRWORA has contributed to the stigmatization of certain immigrant groups and their resultant social stress. In essence, this law created two categories of immigrantsthe "deserving" and the "undeserving"and exacerbated differences between undocumented and legal immigrants; among different types of legal immigrants; and between legal immigrants and naturalized citizens. Although Congress later restored some benefits to elderly and disabled immigrants and legal immigrant children either already receiving these benefits or in the country at the time of PRWORAs enactment, this action might have contributed to the idea that some immigrant subgroups are more deserving than others.

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Fears of health care trade-offs for immigrants turn immigrants into the Other Clark, prof of Law at Loyola Law, 08 (Brietta Clark, Prof of Law, Loyola Law School. 2008 (The Immigrant Health Care Narrative and What it Tells Us About the U.S.
Health Care System. 17 Ann. Health L. 229//ZE)) The ability to transform the dominant narrative, however, is constrained by arguments challenging benefit restrictions along distributive justice grounds. These arguments assert that, rather than protecting citizens, such restrictions harm citizens by erecting additional barriers to care, further straining our healthcare resources, and creating a public heath danger. Denial of access for some groups can also harm the rest of society directly or indirectly. This line of rhetoric, especially the paradigm of health care as a public good, seems designed to create a picture of everyone (citizens and noncitizens) being interconnected in significant ways that challenge the "Us-Them" dichotomy. However, this narrative also can be seen as having serious negative effects, reinforcing part of the dominant paradigm used to justify benefit restrictions. The most obvious rhetorical effect is that it can feed into the narrative of the dangerous immigrant who threatens citizens' economic and physical security. This is probably clearest in the public health justification used to challenge benefit restrictions. Health and legal advocates, as well as law reviews, consistently begin with this fear-based argument: a fear of what will happen if we do not encourage access. 182 Indeed, the few law review pieces that focus on healthcare restrictions for immigrants often begin with some dire warning that fuels this fear. 183 This is also present in claims about dwindling economic resources and the indirect financial consequences of denying immigrants' care. People on both sides of the debate frequently discuss threats to our current healthcare resources, encouraging the public's fear of growing use of emergency services by immigrants and other uninsured. 184 Both seem to use the public's fear to shape policy; the difference, however, is that pro-access advocates offer a different solution to this crisis that requires expanded access to health care. Playing into these fears of dwindling resources can unfortunately reinforce the "Us-

Them" dichotomy by determining our treatment of immigrants based on what we want for ourselves - not based on ethical or moral norms about how they should be treated.

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We stabilize society by making policies to repress the Otherwar is an example of symbolic policies designed to eradicate the enemy Rudolph, Stanford University Press, 06
Christopher Rudolph. 2006 National Security and Immigration: Policy Developments in the United States and Western Europe Since 1945. Stanford, CA: Stanford University Press. Aristide Zolberg suggests, Immigration evokes two very different sets of concerns: one pertaining to national identity and the composition of the political community, the other having to do with economic considerations."" How this is played out politically is considerably more complicated than it first appears. As empirical evidence has illustrated, American national identity as manifest in its laws pertaining to immigration and citizenship reveal two countervailing forcesone civic, one ethnic. Given these multiple traditions, we are faced with an important question: How can we explain variability in these national identity impulses? Why did the U.S. implement ethno-nationalist policy in 1924, abolish it for a more civic-oriented policy in 1965, and then adopt policy that reflected a return to concerns about demographic change in the 1990s? The national security paradigm provides an answer.

Geopolitical structure not only affect the calculation of state interests but also can affect national identity. The presence of external enemies creates an Other that is conducive to national cohesiveness, whereas the absence of such an Other tends to foster perceptions of difference within societies. Internal enemies replace
external enemies. Making this more complicated is that fact that social identities do not remain static, though at any given point they are generally treated as such by members of society. In many ways the story of immigration and border policy development in the United States is about the evolution of American national identity. It is about breaking down the divide between what America aspires to be and what it has been in practice. Immigration policy reflects a continual process toward a true civic identity, one reflecting its aspirations of e pluribus unum. However, this is not necessarily an easily traveled path, as our experience with immigration reveals. Racism and ethnic preferences remain central issues for many in society. Yet, once gains have been made toward more liberal, civic-minded policies, they generally do not revert back to prior policy when sociopolitical conditions change. It is important to note that rising societal insecurities evident since the 1970s have not produced a return to the national origins quota system. Although mainstream citizens may express concerns about migration levels and trends, turning back the clock to an America based on race is simply no longer an option. Instead, pressures for increased restrictions over migration have focused for the most part on retaining sovereignty over the channels of entry and the conditions for inclusion.'" This is a common thread that unites civic-minded and ethnic-minded members of society. Illegal immigration threatens a societys sovereignty to control access to the territory and to the polity. Sociologist Douglas Massey notes that policies in the United States have been largely symbolic, signaling to angry or fearful citizens and workers that their concerns are being addressed while marginalizing immigrants socially and geographically to make them less visible to the public."'' He adds, Repressive policies such a vigorous border enforcement, the bureaucratic harassment of aliens, and the restriction of immigrants access to social services may or may not be effective, but they all serve an important political purpose: they are visible, concrete, and generally popular with citizen voters. ' From the standpoint of grand strategy, the use of symbolic policies during the 1990s enabled the state to pursue liberal economic

integration while keeping domestic anxieties about open borders in check. Border policing has been successful not because it has been able to halt migration flows, but rather because it addressed calls for increased restrictions without significantly curtailing the availability of needed foreign labor. The events of September 1 1 have made accomplishing this delicate political balance much more difficult. However, the fundamental political logic of migration and border control is largely unchanged: policy is crafted to balance national economic interests with security interests. What bas changed is the nature of the security interest and the policy options available to policy- makers given this change. Prior to 9/1 1, security interests pertaining to migration were defined in largely social termsof an alien invasion" of illegal immigrants flouting U.S. law and significantly altering the ethnic demographics in high-immigration regions. Because this security threat was largely perceptual (and entirely political), policymakers were able to respond to perceptions of public threat through the use of largely symbolic policy, enabling them to maintain a system of both de jure and de facto openness toward migration
Hows. By focusing on highly symbolic border policies (such as Operation Gatekeeper) while ignoring the large number of

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"out-of- status migrants, perceptions of threat were mitigated by creating an environment where out of sight was out of mind," at least politically. After 9/11 however, security interests primarily are defined in terms of global terrorism. If out of sight, out of mind" was the rule regarding illegal immigrants prior to 9/11, this is certainly not the case anymore. In fact, the situation is quite the opposite. What this means in terms of policy is that it is not sufficient to simply make illegal immigrants disappear through the use of border policies that disperse flows geographically. Instead, policymakers are faced with two options: reduce migration Bows altogether, or create improved means of screening and monitoring all those who enter the county. The first option would exact a prohibitive cost to the economy and the American national identity as a country of immigrants. Clearly, policymakers have opted for the latter. This desire for an unprecedented level of intelligence and control mechanisms, however, presents tremendous logistical challenges. The empirical evidence shows a tremendous effort to provide such mechanisms, but we remain far from having effective institutions, poli- cies, procedures, and mechanisms in place that achieve the desired balance between openness and security. If successfulin other words, absent another major terrorist attack on U.S. soil in the short-term time frame post9/11 migration and border policies will likely look much like those the preceded them in the 199os. If the United

States is able to avoid another attack, policy restrictivism will likely taper off as perceptions of threat deescalate in the coming years. In that scenario, the appearance of security may suffice to address fears and allow policy to remain largely open. However, should another major terrorist event occur, the ability of the United
States to maintain policies of openness will be jeopardized.

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Status quo health care that deny immigrants health care are important tools to marginalize immigrants. Fear that giving immigrants free healthcare will attract immigrants is part of an irrational fear based on status quo narratives Clark, prof of Law at Loyola Law, 08 (Brietta Clark, Prof of Law, Loyola Law School. 2008 (The Immigrant Health Care Narrative and What it Tells Us About the U.S.
Health Care System. 17 Ann. Health L. 229//ZE)) B. Dominant Narrative The dominant picture in our media and public discourse is created by those lamenting illegal immigration and emphasizing immigration control. A number of scholars have identified that the general

immigration discourse creates an "Us-Them" dichotomy and labels immigrants as "outsiders" or "others" in ways that fuel misunderstanding, fear, and mistrust. 87 Scholars have also documented that in immigration discourse, a vivid picture is painted of "the illegal immigrant" whom we should fear, punish, and exclude.
88 The stereotypical symbol in the discourse has been a male immigrant from Mexico or somewhere in Central America who comes to the United States through deceptive and illegal means, or comes legally, but then overstays his visa only to "disappear" into society in violation of the terms of the visa. 89 Immigrants are seen as a threat to our culture if they fail to assimilate and demand special accommodations for their language difference in schools, hospitals, and the workplace. 90 These concerns are probably further exacerbated by a change in the stereotypical profile of illegal immigrants to Mexican women who come here to give birth to children . 91 These children, though technically U.S. citizens if born here, are still socially and culturally labeled as outsiders who are benefitting from a moral and legal wrong, and thus not truly accepted. 92 Immigrants are also painted as dangerous and a threat to our safety. 93 Certainly, this tendency is heightened after a major terrorist attack or national security threat. 94 However, we also see this trend among Hispanic immigrants, as growing numbers of unauthorized immigrants come from [*244] Mexico and Central America. 95 Stories of violent criminal activity by immigrants from these areas create an image of the "dangerous immigrant." 96 The terms "illegals" and "illegal aliens," used to describe immigrants residing in the United States in violation of immigration law, also reinforce this picture by putting unauthorized immigrants on the same footing as other criminals in our society. In fact, much of the immigration rhetoric mirrors language used in talking about domestic criminal policies. For example, some presidential candidates try to distinguish themselves by claiming to be "tough on illegal immigrants" in the same way that state and local politicians claim to be "tough on crime." 97 [*245] The mere act of coming here through improper channels or violating some condition of legal status taints every other activity of the immigrant while here. Unauthorized immigrants are seen as criminals who come to steal jobs, education, and benefits. 98 Immigrants who need public assistance are viewed even harsher: they are labeled not only as criminals, but as welfare abusers, who steal from the most vulnerable and needy among our citizens. 99 III. Justifying Restrictions to Access. We see much of this dominant narrative reflected in the discourse justifying benefit restrictions on deterrence, distributive justice, and retribution grounds. Policies limiting immigrants' access to healthcare benefits are touted as important tools for discouraging unauthorized and undesirable immigrants, protecting scarce resources to ensure citizens health and safety, and punishing immigrants who violate the law. In the process, they tell a story that reinforces the dominant narrative of immigrants as criminals and welfare abusers who come here to steal benefits and threaten our safety and security. A. Benefit Restrictions as a Deterrent to Illegal or Undesirable Immigration Federal and state officials have repeatedly cited deterrence as one justification for benefit restrictions. 100 To the extent benefit restrictions are justified on deterrence grounds, the discourse must tell stories that link the availability of benefits to immigration decisions about who will come here and how they do it. To support this justification, the discourse must emphasize the nature of immigrants' choices, especially their expectation and desire for such benefits. Although largely contradicted by evidence discussed in the next part, this discourse has nonetheless been asserted in mainstream discourse and generally accepted by courts and the public as a [*246] legitimate justification for linedrawing based on citizenship, at least for adult immigrants. 101 This link between immigration decisions and access to benefits has been reinforced in the justifications used for heightened enforcement mechanisms: namely, to prevent ineligible immigrants (whether here legally or illegally) from "stealing" Medicaid or Medicare benefits. Increasing monitoring for fraud and erecting additional barriers for proving eligibility diverts scarce money and time from other important goals. 102 In order to justify these costs, restrictionists must tell a story of a costly and significant problem of immigrants "stealing" benefits that

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builds upon the general picture of unauthorized immigrants as criminals and welfare abusers. While it is very difficult to link expectations about health care access specifically to immigrants' decision-making, restrictionists have nonetheless created a narrative that tries to do this. The most direct link between health care access and a decision to immigrate is made by focusing on pregnant women who come to hospitals in the United States to give birth to U.S. citizens. 103 This link is used by politicians, such as Texas State Representative Berman and 2008 Presidential candidate Ron Paul, to propose denying automatic U.S. citizenship for these babies in order to cut them off from public health and education benefits. 104 Restrictionists, especially those in border states, create a fear of "anchor babies" and Mexican women darting across the border to give birth. Such fears rely on statistics highlighting the high number of births to unauthorized

immigrants in U.S. hospitals, without any data showing how long the women had been in the United States before the delivery. 105 [*247] The link between health care and immigration decisions is implicitly suggested in popular discussions: the most common complaint about undocumented immigrants and health care is that offering access to "free" emergency care lures undocumented immigrants to the United States, at the expense of tax-paying citizens who subsidize this care and then must suffer overcrowded emergency rooms. 106 One
example of this is found in Lisa Richardson's L.A. Times article, describing the transfer to Mexico of suspected unauthorized immigrants seeking emergency care in U.S. hospitals. 107 The article begins as follows: Jose Lopez stole across the U.S. border with dreams of prosperity and a craving for adventure - but his grand plans didn't last long. On his second day as a fieldworker, a car wreck left him lying in a Brawley roadway with his right leg shattered. Lopez, 19, was taken to Scripps Memorial Hospital in La Jolla, where surgeons put a rod in his leg and wired his broken jaw shut. As Lopez recuperated at the hospital, his bill mounted by the day, and Scripps had no choice but to absorb the cost. Lopez had no money. 108 This attitude flourishes despite the fact that emergencies are by definition unanticipated, and are therefore unlikely to be a primary motivation for entering the United States illegally. Another element of the narrative surrounding health care access is the "foreignness" or "strangeness" of immigrants, which is perceived as threatening the culturebuilding and norm-creation functions of immigration control. In the same L.A. Times article, this element is used subtly through a focus on the differences in the patient's culture and his ultimate choice to return to Mexico. For example, one of the co-founders of Nextcare defended these transfers by describing how they convince patients to go to the Tijuana facility: We ... say, "Let us take you out of this very expensive hospital and take you to our facility in Tijuana,' ... "The level of care you're going to receive is the same, maybe even better. You'll have a physician and nurses you understand. The food is something you're comfortable with. The TV is Mexican. You can call your home and have your family come and visit you.' [Someone] visited Lopez's room at Scripps [offering] to return him to a familiar diet, language and surroundings. 109 [*248] The article also repeatedly emphasizes Lopez's desire to have a good meal and food that was his food, even noting that the San Diego hospital nurses "once whirred a burrito through a blender, at his request." 110 While the description of food was significant because of the nature of Lopez's injury - his jaw was wired shut which meant he could only have liquids and oatmeal - it seems to take on a powerful meaning as a symbol of Lopez's culture as different and foreign to U.S. culture. The language barrier is another powerful symbol of this and can be an important barrier where hospitals or local governments do not provide or adequately fund translation services for non-English speakers. Thus, the undercurrent of "otherness" or "strangeness" of culture that pervades immigration discourse generally is also present in the

rhetoric surrounding immigrant health care access.

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This marginalization maintains a system of violence directed towards illegals Clark, prof of Law at Loyola Law, 08 (Brietta Clark, Prof of Law, Loyola Law School. 2008 (The Immigrant Health Care Narrative and What it Tells Us About the U.S.
Health Care System. 17 Ann. Health L. 229//ZE))

against this backdrop of a financial crisis that a picture is created of immigrants as a threat to the already fragile health system on which citizens currently depend. 121 Indeed, the mere presence of immigrants who are not [*250] entitled to be here or who are admitted on the condition that they not become public charges, seems to threaten public resources, because many immigrants are uninsured 122 and are more likely
It is to serve in dangerous jobs with an increased likelihood of workplace injury or illness. 123 For example, one article by the Center for Immigration Studies, known for advocating immigration control and reduction, highlighted these concerns. 124 The Center for Immigration Studies reported that 30% of all immigrants and their children lack health insurance and receive some kind of public assistance, while immigrant families account for almost 75% of the increase in the uninsured in the past fifteen years. 125 The picture of immigrants as an economic drain is reinforced with statistics about the cost of hospital care for undocumented immigrants. For example, the L.A. Times quoted an estimated annual cost of $ 200 million for facilities in California, Arizona, New Mexico, and Texas and described the cost as "staggering." 126 Restrictionists have blamed the financial crisis in health care on unauthorized immigrants , predicting that care for unauthorized immigrants will force hospitals already on the verge of bankruptcy to close their doors. 127 Recently, the argument has shifted to a more imminent, direct healthcare threat in the form of hospital emergency room closures. Hospital closures are the most visible example of the implications of shrinking healthcare resources and the implications for our health. Rates of hospital closures have exploded in the last decade, especially public hospitals and hospitals treating a high proportion of uninsured patients. 128 As hospitals close, remaining hospital emergency rooms become overcrowded and qualified physicians often refuse to serve on-call or [*251] they leave the community altogether, thereby jeopardizing access and quality of care for everyone. 129 Consider the story of a man from San Diego, California, one of many people concerned about whether Senator Clinton's healthcare plan will provide coverage for unauthorized immigrants and the effect this will have citizens' access: Illegals already have free health care. Drop by any emergency room in your local general hospital and you will likely see a lobby full of Mexicans. It almost cost my 18 month old son his life when on Oct. 6, 2005 he was diagnosed as being in extreme DKU or Diabetic Keto-Acidosis, when I thought he was having an asthma attack. His pediatrician called Children's Hospital in San Diego only to find the emergency room was full. Full of Mexicans I was to find out when I drove him myself to the hospital. Fortunately my son survived, but I felt upset that the resources available for my son were almost denied due to the immigration situation we have here. Hopefully Sen. Clinton's plan will address this issue. 130 Certainly equating Mexican with "illegals" is problematic as a factual and policy matter, and it is not clear from this comment whether the author would support or oppose coverage for unauthorized immigrants in light of his apparent concern about overcrowded emergency rooms. This story is useful, however, in demonstrating the extent to which the very presence of

unauthorized immigrants is viewed as life threatening because of disruptions to emergency care access in the discourse of immigrant health care. These concerns assume a choice between "us" or "them." The numbers of uninsured citizens are compared to uninsured, unauthorized immigrants in need of health care to trigger a public fear that "they" will use up our resources and that none will be left for "us." 131 In fact, the executive
vice president of the Hospital Association of Southern California described the Nextcare "transfers" to Mexico as "a responsible and inventive way of dealing with a shortage of beds for indigent patients" for border states and counties that are "tired of waiting for the federal government to deal with this problem." 132 In other words, hospitals, as well as state and local governments, are in the position of making unfortunate, but necessary, choices about which people will receive scarce healthcare resources.

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Non-citizens become threats to the systemwe wage perpetual war against the other Wilcox, New Hampshire politics, 03
(Lauren Wilcox, New Hampshire politics, 2003 (The New Hampshire Institute of Politics, Security Masculinity. http://www.anselm.edu/NR/rdonlyres/584EAD25-FDAD-484B-AFA9-F8709DBB41FD/1242/Article20033.pdf) The securitization of immigration has intensified since September 11th. In late October of 2001, President Bush stated, The American people are beginning to understand that we fight a two-front war against terror.28 This statement is meant to convey that the War on Terror involves not only military operations overseas, but militaristic strategies to cope with the dangers of terrorism in the United States as well. The second front of operations is focused on controlling the borders of the United States. The moral of the story of September 11th seems to be a lesson about the dangers of allowing foreigners into the country. Increasing border controls became a relatively uncontroversial and widely supported means of preventing future terrorism.29 The securitization and subsequent militarized approach to immigration was solidified with the creation of the National Security Entry-Exit Registration System. To introduce this system, Attorney-General John Ashcroft proclaimed its necessity by equating immigrants (potential terrorists) to a foreign army living among us: In this new war, our enemys platoons infiltrate our borders, quietly blending in with visiting tourists, students, and workers. They move unnoticed through our cities, neighborhoods, and public spaces. They wear no uniforms. Their camouflage is not forest green, but rather it is the color of common street clothing. Their tactics rely on evading recognition at the border and escaping detection within the United States. Their terrorist mission is to defeat America, destroy our values and kill innocent people.30 The Nation Security Entry-Exit Registration System contains a database of fingerprints from known terrorists that can be used to check against persons attempting to enter the United States. It also involves registering persons from countries of elevated national security concern, which includes almost all of the Middle Eastern and North African states and a few Asian countries with large Muslim populations such as Pakistan and Indonesia. Finally, the system entails sending information, photographs, and fingerprints of immigrants who have overstayed their visa, or are not compliant with visa requirements to the National Crime Information System so that they may be apprehended when stopped by the police for other violation, such as in traffic stops. This system specifically targets persons from these countries, subjecting them to greater scrutiny and surveillance than the rest of the immigrant population, with a greater risk of detainment and deportation. That immigration is now being treated as a matter of national security is suggested by the use of these surveillance and other technologies in the process of deciding who to allow into the United States. The creation of vast databases of information about immigrants designed to be quickly accessible to consular staff, border patrols, and law enforcement is one manifestation of the securitization of immigration. Furthermore, biometric information about visa applicants will soon be collected.31 Agencies of the Immigration and Naturalization Services (INS), the Coast Guard, the Border Patrol, the Customs Service have been reorganized into the Department of Homeland Security. This shift combines agencies that deal with immigration into the same department as law enforcement agencies. Secretary of State Colin Powell, in the summer of 2002, noted to the House Select Committee on Homeland Security, As you know, our first line of defense in protecting ourselves from those who would come to our shores are our diplomats at our consulates and other location around the world, where we issue visas to people to come to America. The United States is ready to make sure that our visa system is a strong one, a secure one, but at the same time, one that encourages people to come to the Untied States, once we have made sure that they are the right kinds of people to come into our nation, they are not coming in to conduct any kind of activity which would be injurious to any American.32 This statement not only suggest the securitization of immigration, but also the nature of this process as being based on a certain idea of national identity, in which the government has the power to determine who are the right kinds of people who are to be allowed in (with special scrutiny towards persons from Northern African and Middle Eastern states). The connection between immigration and security is not obscure; in fact, the issue of immigration can be crucial to securitization, as it

is linked to the loss of a control narrative that associates the issues of sovereignty, borders, and both internal and external security.33 Identity and Securitization As David Campbell argues, security and identity are inextricably linked; what constitutes a security threat creates what is defined as the identity of a nation. A notion of
who/what we are is intertwined with an understanding of who/what we are not and who/what we fear.34 Thus, the dangers that threaten us and our identity are located not only geographically outside of the nation, but are outside of the national system of values and identity. They are, in fact, the antithesis of what we are. Simultaneously to process of securitizing terrorism, definitions of American identity were advanced. During the State of the Union speech in January of 2002 and elsewhere, Bush defined what he believed to be the character of America and its core

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values, especially in opposition to those of the terrorists. It should be noted that this is a mere sampling of many similar statements made by President Bush as well as many other top government officials and commentators. During the past few months, Ive been humbled and privileged to see the true character of this country in a time of testing. Our enemies believed America was weak and materialistic, that we would splinter in fear and selfishness. They were as wrong as they are evil. We have a great opportunity during this time of war to lead the world toward the values that will bring lasting peace. America will always stand firm for the non-negotiable demands of human dignity: the rule of law; limits on the power of the state; respect for women; private property; free speech; equal justice; and religious tolerance. Deep in the American character, there is honor, and it is stronger than cynicism. Our enemies sent other peoples children on missions of suicide and murder. They embrace tyranny and death as a cause and a creed. We stand for a difference choice, made long ago, on the day of our founding. We choose freedom and the dignity of every life.35 There is a value system that cannot be compromised, and that is the values that we praise. And if the values are good enough for our people, they ought to be good enough for others, not in a war to impose because these are God-given values. These arent United Statescreated values. These are values of freedom and the human condition and mothers loving their children.36 Ours is a country based upon tolerance And were not going to let the war on terror or terrorists cause us to change our values.37 In pursuit of our goals, our first imperative is to clarify what we stand for: the United States must defend liberty and justice because these principles are right and true for all people everywhere.38 In the war against global terrorism, we will never forget that we are ultimately fighting for our democratic values and way of life. Freedom and fear are at war.39 The characteristics we most cherishour freedom, our cities, our systems of movement and modern lifeare vulnerable to terrorism.40 In all of these statements, President Bush defines American values and identity in very stark terms. Strength, freedom, liberty, justice, dignity of life, rule of law, rights of women, modernity, tolerance and private property are all American values. The enemy, the terrorists, stand for the exact opposite: evil, tyranny, death, anarchy, oppression of women, fear, backwardness and barbarism. This discourse sets up clear, normative, distinctions between us and the terrorists, making it easy to marginalize, vilify and dehumanize not only terrorists, but also all those associated with these characteristics of terrorism. By demarcating the boundary between an inside of Americans and American values, and an

outside of foreigners and un-American values, making borders more closed to immigrants follows logically. Throughout American history, immigration policy has been based upon supposed threats to American culture and societal cohesion, and has served to keep out undesirables.41 The securitization of
immigration is especially important in defining American identity, as migration is at the focal point of the interrelated dynamics of identity, borders, and orders.42 In September of 2002, reporter Michelle Malkin published Invasion: How America Still Welcomes Terrorists, Criminals, and Other Foreign Menaces to Our Shores, with the overarching theme that immigration must be treated as a national security problem. Her rationale goes beyond the fact that the perpetrators of the September 11th attacks were foreign nationals, as her book details stories of immigrants, both legal and illegal, who murdered police officers and innocent people, dealt drugs and were involved in other instances of political violence. Immigrant communities, not just the immigrants who are terrorists per se have also been blamed for the terrorist attacks, because large populations of un-assimilated immigrants (from Islamic countries, in this discourse) can make it easier for a terrorist to blend in. As one columnist argued, The Sept. 11 attacks have made change a much graver matter. Cuts in legal immigration would contribute to improved security by permitting more efficient management and by denying terrorist cover.43 As noted from Ashcrofts statement on the Nation Security Entry-Exit Registration System, immigrants are a threat because they are able to blend in and move unnoticed. This is due to the very fact that there are significant populations of relatively unassimilated immigrants, denoting all immigrants as potential threats, either as terrorists, or for their mere presence that obscures the presence of more outsiders. Overall, the consequence (or perhaps intention) of the securitization of immigration has been to associate immigration and immigrants with

discourses of threats and danger not only as terrorists threatening our physical safety but our culture and way of life.

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We use Others to define us and our actionsperception of dangerous Others is the root cause of war Rudolph, Stanford, 06
Christopher Rudolph. 2006 National Security and Immigration: Policy Developments in the United States and Western Europe Since 1945. Stanford, CA: Stanford University Press. In the early 1990s, Myron Weiner argued that the features of population movement suggest the need for a security/stability framework for the study of international migration that focuses on state policies toward emigration and immigration as shaped by concerns over internal stability and international security ' The present book attempts to do just that by simultaneously addressing two central questions: (1) What role does international migration and border control play in national security? (2) How do security interests affect the timing and form of immigration and border control policies? Although sizeable literatures have been developed on the issues of security (primarily political scientists and historians) and immigration (in social sciences, humanities, and law), these have, for the most part, proceeded along largely separate paths. Only recently has scholarship begun exploring the relationship between the two.2 The purpose of this book is to illustrate the important linkages that exist between national security and international migration, and perhaps more importantly, to establish the first steps in theorizing state behavior that stems from this interaction. A More Comprehensive Framework of Security National security" has generally been defined in very limited terms, consisting primarily of issues related to interstate military conflict. As the post- cold war environment presents a more complex security system, we are beginning to see new thinking about security that is better able to more accurately capture the new dynamics at play in world politics . Barry Buzan argues, Understanding the national security problem requires a wide-ranging understanding of the major levels of analysis and issue sectors that comprise the field of International Studies. Although the term national security suggests a phenomenon on the state level, the connections between that level and the individual, regional and systems levels are too numerous and too strong to deny. 3Some security scholars may be reluctant to embrace the more comprehensive and complex characterizations of security because they threaten the orthodox view that the realm of "high politics" must remain distinct from the realm of low politics. The security paradigm proposed herein is intended to provide a theoretical framework that allows some sense of how "high" and low" politics are in many ways interdependent. Although they may exist in an anarchic global system, nations are not always in a state of conflict. We are then left with an important question: What drives politics when geopolitical (military) threats decline? Constraining our thinking about security solely within the domain of high politics provides no tools to address this question. The theoretical framework offered in this book provides a means to identify both external and internal facets of security, and to explore the relationships between them. Taken together, the Threat and Rally Hypotheses provide a rationale for Why societal security interests decline in relative importance in the formation of state grand strategy when geopolitical military threats are acute, and also how and why these priorities change as the Still cultural environment shifts over time. The framework provides a means to accurately describe, and perhaps predict, the changing priorities of grand strategy that emphasize some combination of external and internal security interests. It also illustrates how the geopolitical security environment can shape national identity. Some critics have suggested that the concept of societal security" is flawed because it imposes a rigid, "near positivist" view of identity on society: "Identity is not a fact of society; it is a process of negotiation among people and interest groups.* The concept is not utilized in this fashion within the context of the framework offered herein-in fact, it is quite the opposite. What is important to recognize in questions regarding national identity is that, even though it may, in fact, be in a continuous state of flux: as a result of public deliberation, it is rare (I would argue, nonexistent) that proponents of any particular type of national identity receive of it in such fluid terms. Rather, individuals and groups simply have competing views of a largely static conceptualization- or are arguing for the replacement of an existing dominant idiom to be replaced with a new dominant, largely static concept. For example, the ethno-nationalist rhetoric of social conservatives in France, such as Jean-Marie Le Pen, conceives of an enduring French society based largely on issues of ethnicity and culture. In contrast, social liberals staunchly defend the civic-nationalist concept of lai-cit and have passed laws restricting religious dress in public schools in order to maintain continuity of a national identity conceived of in terms of ideology and common interests. Each has an idealized vision of French nation-hood that provides an enduring sense of purpose, place, and meaning. Even though contrary and conflicting conceptions of nationhood may be present in a society, a dominant idiom of national identity can be identified at a given point of time and may remain dominant across a given period. When examining internal, societal security" interests, this does not suggest that a dominant idiom is presupposedreifying it as an object of security. Rather,

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it suggests that policymakers are responsive to perceptions of the dominant national identity, may also influence popular conceptions of national identity by leading public discourse, and are compelled to respond to threats against this identity with new policy. Even though national identity may be evolving over time, societal security interests are reflected in policy outcomes at specific points in time. The available empirical evidence suggests that these dynamics are applicable to both generally civic-oriented nations, such as the United States, France, and Great Britain, and generally ethnic-oriented nations, such as Germany. Although national identity is often conceived in primordial terms that presuppose enduring qualities over time, the empirical evidence presented herein suggests that conceptions of nationhoodin terms of deciding who we" arecan be affected by the presence or absence of an external enemy as well as other elements of the structural environment, including patterns of international migration. Samuel Huntington argues, "To define themselves, people need an other. Extending this logic to society writ large, he adds, "National unity is enhanced as potentially divisive internal antagonisms are suppressed in the face of a common enemy. Clearly, we can expect an increased likelihood of the opposite effect when external enemies decline. Many policymakers are keenly aware of these social dynamics and the "energizing force that external enemies can have on internal social cohesion. As the cold war drew to a close, an advisor to Soviet leader Mikhail

Gorbachev remarked, "We are doing something really terrible to youwe are depriving you of an enemy." Patterns of international migration can also challenge conceptions of national identity, depending on the volume and compositiion of flows. As the available evidence makes clear, large-scale immigration flows can have a profound effect on social demographics in receiving countries, and this effect can be magnified if immigrant
birthrates are significantly higher than the native population, as is the case in the United States and Western Europe.

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Contention 2 is solvency. The point of the plan is to integrate immigrants by using the system that has been used to keep them out. Challenging notions of who deserve health care changes preconceived narratives of immigrants that drive security logic Clark, prof of Law at Loyola Law, 08 (Brietta Clark, Prof of Law, Loyola Law School. 2008 (The Immigrant Health Care Narrative and What it Tells Us About the U.S.
Health Care System. 17 Ann. Health L. 229//ZE)) Increasingly, attention is being paid to the significant harmful effects on immigrants as well as the deleterious public health effects of these immigration-related benefit restrictions. This article examines the political, legal, and popular discourse in favor of and against healthcare benefit restrictions for immigrants in order to focus on a different aspect of this problem. Through this discourse, narratives are created of immigrants' character and relationship to the rest of society. These narratives influence our perception of immigrants and their effect on society, and this perception, in turn, seems to influence the policies enacted to regulate immigrants and immigration. These narratives have

been constructed predominantly by those advocating for increased immigration control and benefit restrictions designed to make life in the United States for unauthorized immigrants less tolerable. Arguments
favoring benefit restrictions reflect the narrative of an "Us-Them" dichotomy in which immigrants are labeled as criminals and welfare-abusers who jeopardize the health care of law-abiding citizens. Advocates for expanded health care access try to undermine this dominant narrative and offer a different one that portrays a more positive and complex relationship between immigrants, the health care system, and society generally. For example, those challenging benefit restrictions paint a very different picture of immigrants as self-sufficient, generally law-abiding, especially vulnerable to discrimination, and fearful of using public benefits. Immigrant rights groups and legal scholars also argue that many immigrant benefit restrictions are unduly harsh, racist, 18 and irrational because they undermine public health goals. 19 It is important to examine this discourse and determine the true impact of the immigrant health care narratives on policymaking. Narratives can influence popular opinion and grassroots coalitions that can either facilitate or hinder public advocacy for expanded access. They also help create or undermine the political will exerted on policy makers. But can pro-access [*232] advocates reconstruct the immigrant health narrative in a way that leads to greater health care access for immigrants? To the extent that pro-access groups hope to influence policy making through these reconstructed narratives, they should recognize two very important challenges they face.

Our plan is a pre-requisite for any increase in social services for immigrants Arrighi and Maume, professors of Sociology and University of Cincinnati, 07
(Barbara A. Arrighi, David J. Maume, 5/30/2007, professors of Sociology and University of Cincinnati, Child Poverty in America Today: Health and Medical Care Volume II p. 130) Census 2000 indicates that one of four people in the United States was born outside its borders, with substantial numbers having entered after the liberalization of immigration laws in 1965, consequently, U.S. society is becoming increasingly aware of ethnic and cultural differences between immigrants, particularly those of color and the nativeborn populations. Interest in understanding attitudes, values, religions, and behaviors is reflected in the burgeoning literature on immigrants and refugees. Social service agencies have often had to mediate between immigrants and the U.S. institutions as newcomers learn to adapt to their new environments. In this process, the environment has begun to become sensitized to the diversity of the new arrivals.

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Utilizing social services to integrate immigrants de-marginalizes them Arrighi and Maume, professors of Sociology and University of Cincinnati, 07
(Barbara A. Arrighi, David J. Maume, professors of Sociology and University of Cincinnati, 5/30/2007, Child Poverty in America Today: Health and Medical Care Volume II p.130)

Social service agencies have often had to mediate between immigrants and U.S. institutions as newcomers learn to adapt to their new environments. In the process, the environment has begun to become sensitized to the diversity of the new arrivals. Less focus has been placed on the systematic understanding
of the socioeconomic levels of these immigrant groups and their implications for adaptation and achievement. Based on the allocation of immigration visas, there have been a variety of legal immigrant streams that have entered the United States in the last few decades. While earlier immigrants of the 1960s were, primarily of a professional stream , current streams are more likely to include large numbers entering throughout family reunification processes. These individuals and groups may not have the human capital and skills that are readily transferable into the fastpaced technological society. Consequently, the promised land of milk and honey may not be so for them. Two additional populations to the United States, refugees and undocumented immigrants, may find that they are frequently on the fringes of societythe former for a significant portion of their lives. and the latter, almost for their entire stay in the United States. Thus, a large segment of the immigrant group, particularly the newer immigrants of the last decade, is likely to be marginalized. Without the requisite English language competencies, education, and usable job skills, many hover at poverty levels.

Immigrants wont strain the health care system Clark, prof of Law at Loyola Law, 08 (Brietta Clark, Prof of Law, Loyola Law School. 2008 (The Immigrant Health Care Narrative and What it Tells Us About the U.S.
Health Care System. 17 Ann. Health L. 229//ZE))

public health benefits are not a motivating factor for immigrants are also supported by the data on immigrants use of health services. Studies show that immigrants, especially unauthorized immigrants, underutilize healthcare benefits.'" Even legal immigrants and children of immigrants entitled to care tend to underutilize the healthcare system as a result of immigrationrelated benefit restrictions and enforcement policies." Moreover, some data suggests that immigrants are much more likely to pay for their health care than citizens in many cases, undermining the view of immigrants as welfare abusers ." For
Pro-access arguments that example, although there are many reasons why immigrants may have trouble getting insurance and may need to rely on public benefits or assistance initially. data suggests that this reliance tends to be temporary and that "within a decade, new immigrants in Califomia moved up quickly to steadier jobs with more benefits, and the rates of uninsured immigrants dropped sharpIy."" All of this underlying-motivation data is consistent with a trend that many scholars and immigrants rights groups have found to result from increased restrictions and stepped-up immigration enforcement. Illegal

immigration continues and has even grown, despite the recent laws that make it increasingly difficult for unauthorized immigrants to live in the United States." Illegal immigrants are still crossing the border, and
they literally live as outlaws in hiding because these restrictionist policies have made life much harder for them. Many flock to urban areas where they can more easily "disappear" or blend in to society, while those in less urban areas try to avoid contact with others as much as possiblem These laws may deter immigrants from seeking certain kinds of benefits and keep them segregated in society, but they do not deter immigration decisions and they cannot deter immigrants need for care for injury or illness that is beyond their control.

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Squo=Racism
Squo health care regime entrenches racism
Manrique, masters at econ and management, Lund University, 09 Victoria C Moreno Manrique, econ and management, Lund University, 2009 <http://biblioteket.ehl.lu.se/olle/papers/0003370.pdf>

Immigrants will tend to present lower levels of quality adjusted life years compared to natives. Their differential on QALYs will be low due to their worst socio-economic situation, the distress associated with the event of migration and health investments done prior to migration. None of these reasons seems to be associated
to their own responsibility. Because previous investments on health will have been constraint to factors concerning their country of origin, it does not seem reasonable to accept the inequalities related to this aspect. Consequently, immigrants should be expected to be given higher equity weight within the fair innings argument. Their life expectancy at birth is lower than the native population and so will also be their quality of life. Because the fair innings level and the equity weight are constructed based on societys willingness to forego health, it is probable that immigrants will not be given the same weight as a native. Neither will their level of fair innings will be consider the same. This will not necessary be due to pure (or only) discrimination but to risk aversion. Natives will know they are not part of the worst off group and therefore decided their willingness to forego solely based on their aversion to inequality, whereas if they were under the veil of ignorance the risk of being part of the worst-off will increase their willingness for a more equal distributed society. Another problem with societys preferences is its tendency to present willingness to discriminate according to responsibility, which raises two issues. First, level of aversion to inequalities might come from failure of society to understand which factors are controllable and which are uncontrollable. Second, it could also be affected by individuals willing to discriminate even for the uncontrollable factors (due to e.g. racism).

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Immigrants Help Econ-Housing Market

Immigrants are playing a key role in mending the economy through the housing market Waslin, Senior Policy Analyst at the Immigration Policy Center, 7-1, (Michele Waslin, Senior Analyst at the
Immigration Policy Center, 7-1-09, http://www.laprogressive.com/2009/07/01/immigrant-homebuyers-play-crucial-role-in-housingmarket-revival/) Despite the bad news, The State of the Nations Housing 2009 reports that demographic moorings of future demand remain strong.

The largest generation in American history will be reaching young adulthood in record numbers over the next decade. The echo boom generation (anyone born between 1976 and 2001, roughly 98.8 million) is larger than the baby-boom
generation (anyone born between 1946 and 1964, roughly 75.8 million), and even with relatively low immigration levels, echo boomers should reinvigorate the housing market over time However, even in light of the echo boom generation, the study indicates that immigrants and their children also make up

an important part of the new house-buying demographic. Minorities are likely to fuel 73% of household growth in 2010-2020, with Hispanics leading the way at 36%. Immigration levels are a wild card that could either dampen housing
demand or lift production even higher. In other words, if the recession continues and fewer people come to the U.S. because of decreased job availability, that lack of potential immigrant home-buyers could have a negative impact on the housing market.Other experts have noted that immigrants are an important element of the housing market. Demographer Dowell Myers notes that Latino immigrants in California exhibit exceptionally large gains in homeownership within the first generation. Over the next 20 years the ration of seniors (ages 65 and older) to working-age adults (ages 25-64) will increase dramatically. Immigrant

homebuyers are also crucial in buying homes from the increasing number of older Americans. Back in April, Alan Greenspan told the Senate Subcommittee on Immigration, Refugees, and Border Security that an influx of skilled immigrant workers would help the housing market and the financial system because: skilled [immigrant] workers and their families form new households. They will, of necessity, move into vacant housing units, the current glut of which is depressing prices of American homes . And, of course, house price declines are a major
factor in mortgage foreclosures and the plunge in value of the vast quantity of U.S. mortgage-backed securities that has contributed substantially to the disabling of our banking system. In addition to being workers, taxpayers, and consumers, immigrants also buy homes. Immigrants who buy homes help the economy and further integrate into American life. Throughout the ongoing immigration debate, we need to remember that immigrants are multi-dimensional and contribute to the U.S. and the economy in many crucial waysand the sooner we bring the roughly 12 million undocumented immigrants out of shadows and onto the right side of the law as tax-paying, hardworking, home-buying citizens, the sooner our economy can recover.

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2AC- Plan Helps Econ

Lack of preventive healthcare costs much more money in the long run Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

Economic inefficiency is another problem with the current legislation. 83 The Welfare Reform Act denies illegal immigrants access to preventive care, but provides that public health care facilities are required to treat emergency conditions for all people, regardless of their immigration status or their ability to pay. The
current legislation, therefore, takes a back-end approach to providing illegal immigrants health care access by providing emergency services. However, this approach is critically flawed because it is more expensive to provide emergency care than it is to take a front-end approach by providing preventive care. 85 Dissenters of taking a front-end approach dispute that providing emergency care would be more costly than providing preventive care and claim that preventive care drains local resources that would be better used serving the documented population. 86 However, these dissenters fail to realize that emergency treatment can cost nearly "four to ten times as much" as providing

preventive care. The cost discrepancy exists because it costs less for health facilities to treat symptoms and conditions before they "degenerate into emergencies that necessitate more elaborate procedures and care," which could include much more expensive services such as intensive care and hospitalization. 89 Doctors and other health care officials have expressed similar concerns. 90 One doctor commented, "It's been our view that from a good public health policy perspective, we would provide preventive care so as to avoid the higher cost of emergency cost and hospitalization, which we would be forced to provide." 91 Adding to
the economic inefficiency of the Welfare Reform Act is the Immigration Reform Law, which does not allow states to provide security against potential deportation if illegal immigrants decide to access the available emergency care. Illegal immigrants must, therefore, fear the possibility of having their immigration status reported to the INS and

risk subsequent deportation if they choose to access available emergency care. Thus, illegal immigrants are unlikely to access treatment for emergency [*582] services until they are "supersick" 92 because they risk having their immigration status reported to the INS. This risk arguably places illegal immigrants in a dilemma where their condition might already qualify as an emergency condition, but because of the significant risk involved in seeking the available treatment, they may undesirably choose to wait until their conditions worsen and degenerate into an even more complicated situation. At which time, conditions may require much more complicated and expensive procedures or treatment. The same legislation is also economically inefficient
when considering the cost discrepancy between treating an outbreak of infectious diseases against providing illegal immigrants with preventive treatment, which lessens the likelihood of the infection and subsequent spread of communicable diseases. 93 As discussed earlier, the illegal immigrant population, because of their often poor,

and less than ideal living situation, is at a much greater risk for the infection and transmission of infectious diseases. 94 The same problem with the back-end approach, comprised of strictly providing emergency services, applies in the context of infectious diseases because it is less costly to "prevent infectious diseases . . . early-on than to wait until the acute stage and risk exposure to the general community." 95 Experts have expressed similar concerns. Professor Linda Bosniak stated that, "people afraid to go to the doctor will simply create the conditions for a public health catastrophe and will end up costing the state more money later on." 96

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2AC- Econ Add-On

Status quo requires hospital to pay cost for uninsured in emergency medical care causing closures and hospital insolvency Rubenstien, President of ESR Research Economic Consultants, 09
(Edward S. Rubenstien, President of ESR Research Economic Consultants in Indianapolis, Director of Research at the Hudson Institute and a columnist for Forbes. Winter 2008-2009. The Social Contract Press Volume 19, Number 2)

Immigrants are disproportionately employed in low-wage jobs, small firms, and service or trade jobs that are less likely to offer health benefits. More than 46 percent of foreign-born noncitizens were uninsured in 2006three times the
uninsurance rate of native-born persons (15 percent). Most of the growth of the uninsured population is due to immigration: Over the 1994 to 2006 period, immigrants accounted for 55 percent of the increase.2 Although recent immigrants are the most likely

to be uninsured, even the oldest immigrant cohortsthose who arrived prior to 1970are nearly twice as likely to be uninsured than natives. Legal immigrants are eligible for Medicaid, the federal insurance program for the indigent, after
five years in the U.S. Although illegal immigrants are barred from medical benefits except for emergency room care, their U.S.-born children are entitled to the full gamut of services. An estimated 3 million such anchor babies are living in the U.S. Medicaid

spending on behalf of immigrants has increased far more rapidly than the amounts paid for native-born recipients. Hospitals are required to care for Medicaid beneficiaries as a condition for receiving federal tax exemptions. This is a financial burden for hospitals, however, because Medicaid reimbursements do not cover the full cost of services. Medicaid underpaid hospitals by $11.3 billion in 2006, up from $2.6 billion in 2000. This translates a payment
of 86 cents for every dollar spent by hospitals caring for Medicaid patients in 2006.3 Uncompensated health care costs have created a two-tier hospital system. Treatment at safety net hospitalsthat is, those catering primarily to immigrants and other Medicaid patientslags behind that offered at facilities that do not treat large numbers of such patients: Hospitals with high percentages of Medicaid patients had worse performance in 2004 and had significantly smaller improvement over time than those with low percentages of Medicaid patients. Hospitals with low percentages of Medicaid patients improved composite acute myocardial infarction performance by 3.8 percentage points vs. 2.3 percentage points for those with high percentages. Larger performance gains at hospitals with low percentages of Medicaid patients were also seen for heart failure (difference of 1.4 percentage points, P=0.04) and pneumonia (difference of 1.3 percentage points, P<.001). Over time, hospitals with high percentages of Medicaid patients had a lower probability of achieving high-performance status.4 Uninsurance v. Infrastructure This is a boom time for hospital construction. A record $41 billion in hospitals and clinics was under construction in the fourth quarter of 2007. Despite the credit crunch and recession fears, medical infrastructure construction growth is expected to continue in the low double digits through 2009.5 There are several reasons for the building boom: obsolete facilities, new technology that improves the efficiency and quality of hospital care, and seismic code changes that require replacing buildings in California. Overarching everything is the aging of the babyboom generation. Abut three-fifths of hospitals of surveyed by the American Hospital Association (AHA) in October 2007 either had projects under construction or planned to initiate construction of new projects within three years. Unfortunately, many hospitals cannot afford to replace inferior facilities. They are deterred by the double whammies of rising uninsured case loads and declining federal reimbursement rates for Medicaid patients, which provide 60 percent of the income received by some safety-net hospitals: As you continue to fight reimbursement issues at a facility and youre trying to upgrade, it becomes difficult, says Donna Craft, executive director of support services, NorthEast Medical Center in Concord, N.C. It is getting much harder to elevate the aesthetic standards and the bottom line.6 Making matters worse is that the cost of hospital construction is highest in immigrant gateway cities such as New York, Los Angeles, San Francisco, and Chicago. The Emergency Department Emergency departments are the most common item found on the infrastructure wish lists of U.S. hospitals. Architect and engineering expert Joseph Sprague, director of health facilities for the Dallas-based architectural firm HKS Inc., says that almost every project his firm does has some sort of emergency department (ED) component: The ED has become the front door of the hospitalPeople go to use the emergency room and they end up using the hospital. 7 But EDs are an endangered species. The number of EDs fell from 5,108 in 1991 to 4,587 in 2006a 10-percent decline. Over the same period ED visits increased by a whopping 33.8 percent. A Centers for Disease Control (CDC) study found that half of EDs experienced overcrowding in 2003 and 2004. An ED is deemed to be crowded if ambulances had to be diverted to other hospitals; if average waiting time for urgent cases was 60 minutes or more; or if at least 3 percent of patients left before being treated.8 People die from these delays. Autopsies of accident victims who died after reaching EDs in San Diego hospitals suggested that 22 percent of the deaths were preventable.9 Illegal immigration is a major factor behind the

ED emergency. On the demand side, illegal aliens utilize hospital EDs at more than twice the rate of the overall

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U.S. population: 29 percent versus 11 percent.10 On the supply side, uncompensated illegal alien care is the cause of many ED closures. Not surprisingly, California EDs are among the hardest hit. Fox News reports that Sixty percent of [LA
Countys] uninsured patients are not U.S. citizens. More than half are here illegally. About 2 million undocumented aliens in Los Angeles County alone are crowding emergency rooms because they cant afford to see a doctor.11 In the last decade, 60 California emergency rooms closed. One federal law in particular has made things worse. The Emergency Medical Treatment and Labor

Act (EMTALA), enacted in 1986, requires that every emergency department in the country treat uninsured patients for free. Naturally, this includes immigrants and illegal aliens. EMTALA defines medical emergency as any complaint brought to the ED, from hangovers to hangnails, from gunshot wounds to AIDS. The hottest ED
diagnosis, according to medical lawyer Madeleine Cosman, is permanent disability a vaguely defined condition that covers mental, social, and personality disorders.12 Drug addiction and alcoholism are among the fastest growing of such disabilities. A disability diagnosis automatically qualifies illegal aliens for Supplemental Security Income, a federally funded cash transfer payment . Fines of up to $50,000 are imposed on hospitals refusing to treat ED patientseven when the attending physician examines and declares the patients illness or injury to be a non-emergency. Lawyers and special interest groups are granted more authority than doctors in these matters. EMTALA was supposed to make EDs more accessible to the uninsured. Talk about unintended consequences! Not only did this unfunded mandate contribute to the closure of numerous emergency

departments and trauma centers, it also created a perverse incentive for hospitals to tolerate emergency department crowding and divert ambulances while continuing to accept elective admissions. Rather than improving access to emergency care, EMTALA diminished it.13 Current Healthcare policies put the system on the brink Marie Shields, editor, 7-11
(Executive Healthcare, 7-11-09, http://www.executivehm.com/article/Issue-6/Technology/On-the-Frontline/ )

Americans dont want to be told they cant get the care they think they need. David Blumenthal leads the fight to keep our healthcare system from the brink of collapse. Were constantly being told that our healthcare system is in crisis. Healthcare has become a hotly debated national issue, with medical costs soaring and more than 45 million Americans uninsured. And were not the only ones under pressure. According to a recent report by analysts PricewaterhouseCoopers, HealthCast 2020: Creating a Sustainable Future, There is growing evidence that the current health systems of nations around the world will be unsustainable if unchanged over the next 15 years. Globally, healthcare is threatened by a confluence of powerful trends increasing demand, rising costs, uneven quality, misaligned incentives. If ignored, they will overwhelm health systems, creating massive financial burdens for individual countries and devastating health problems for the individuals who live in them. Yet oddly enough, most of
us here in the US still have faith in our healthcare system, even believing it to be the best in the world. This gap between perception and reality is puzzling, but Dr. David Blumenthal has an explanation. Right now, on a daily, individual basis, the majority of Americans receive the care they need when they need it, which can obscure the deterioration driving the bigger picture. And the

bigger picture is something that, as Director of the Institute for Health Policy (IHP) at Massachusetts General Hospital, Blumenthal is certainly familiar with. Our healthcare system does have huge problems, he says. Its in a crisis, but its a slow one. Most of us are still able to afford good healthcare because were a rich country. We can expend 16
percent of our GDP on healthcare, get mediocre results, and still feel that were doing okay. Blumenthal, however, doesnt see this situation remaining feasible for much longer. Within policy-making circles, and even in some sectors of the business community, there is a sense of urgency about where the system is evolving to. Among the general population, I dont think a sense of crisis has occurred yet, though it could, if we have a deep, long recession as part of the current economic crisis. What

is a slowly evolving collapse could be accelerated dramatically, because businesses will back out of insurance provision and cut back on insurance, and many middle class families will start to feel vulnerable. Right now the
84% of Americans who have health insurance can still get the care they need; its only that minority of 16% who are affected. Thats not enough to communicate to the electorate as a whole the sense of urgency that is needed to turn the system upside down.

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This crisis is escalating and will spill over to collapse the economy Brian Klepper, PhD/Healthcare Market Analyst and David Kibbe, M.D., 3/17/2009
(The Intensifying Collapse of the Health Care System, Why It's Different This Time, and What We Need to Think About Along the Way. http://healthpolicyandmarket.blogspot.com/2009/03/intensifying-collapse-of-health-care.html)

As coverage erodes, we are most concerned about the hospitals and health systems that are the anchor health care resources in most communities. With the economy and stocks tanking, the investment income that was keeping many health systems afloat has disappeared. The ranks of the uninsured and underinsured have exploded, so uncompensated care costs and bad debt are skyrocketing. Few health systems have gotten serious about huge supply chain
margins, often north of 50 percent, so there's nowhere to turn in the short term. While safety net short term acute care facilities have been under duress for many years, now these trends are conspiring to also threaten the community facilities that cater to those with more resources. One recent survey of 4,500 health systems, published before the economy really began to plummet, found that more than half were "technically insolvent or at risk of insolvency." As the economy has worsened, and jobs and money evaporate, many patients are breaking physician appointments or are unable to pay for services received. Bad debt has become much more of a problem for physician practices, so many have become more aggressive in collections. We have received anecdotal reports that some physician practices are demanding payment in full prior to procedures, and are balance-billing their health plan patients in direct violation of their contractual agreements. The health plans aren't positioned to police every practice's policies. But if this trend is widespread in the system, it suggests that the niceties of business practice are going by the wayside as practices struggle to maintain. Finally, the combination of health coverage erosion and high care costs is fueling an arms race that, until fixes are in place, patients will lose. The two fastest growing segments of the health care financial sector are individual credit scoring and collections, specifically aimed at capturing available dollars for the system. In this economy, aggressive collections practices will drive many more patients into bankruptcy, intensifying consumer dissatisfaction and further fueling the engines of change. Is Health Care A Bursting Bubble? One of us recently had a 3.5 hour diagnostic procedure at a local hospital outpatient surgery center. The EOB (Explanation of Benefits) from the health plan showed the hospital had submitted a facility charge of just over $13,000 - more than four months of total income for one-third of American households - and the health plan paid approximately $1,300, which means that willing vendors and purchasers agreed that the procedure's market value was 10% of the charge. But without insurance, we would have been legally responsible for that bill, with the willingness to negotiate utterly at the discretion of the health system. Setting aside the fact that charges are crazily tied to the evolution of Medicare cost reports and grow out of stuffing every bit of possible cost into each charge, the EOB begs three questions. 1. Is it appropriate to add a 1,000% surcharge for the sin of uninsurance. For not-for-profit health systems especially, is it appropriate to do so while receiving a tax break for providing community service? 2. When a provider chooses to pursue a receivable figure that is more than the established market value (as determined through the contractual figure with the health plan), can that effort properly be understood as inflating the market? 3. Can a system maintain stability when it inflates value beyond the means of most of its purchasers ? The definition of a market bubble is a high variance between the intrinsic value of a product and its market valuation. Bubbles always burst eventually, as inflated market values tumble back towards intrinsic value. We're seeing this with homes and banking stocks. Are we there yet with health care services? Could America's health system collapse? The Threat It's hard to imagine the health care system in free fall. The federal government pays for approximately half of health care already, through allocations for Medicare, Medicaid, SCHIP, the VA, and the Federal Employees' Benefit Program. The stimulus bill allocates a "down payment" of $634 billion for health care reform over the next ten years, assuming that somehow this money will go to save health care dollars. But it could just as easily become a bail out for the failing health care sector, massively larger than the bailouts for the banks or the autos, and "too large to fail." Keep in mind that

health care is now 16 percent of the US economy, one dollar in seven and one job in eleven, so large that any significant disruption in the sector would inevitably cascade to all other parts of the economy.

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Economic collapse causes World War Three Mead, 9 Henry A. Kissinger Senior Fellow in U.S. Foreign Policy at the Council on Foreign Relations
(Walter Russell, Only Makes You Stronger, The New Republic, 2/4/09, http://www.tnr.com/politics/story.html?id=571cbbb9-2887-4d81-8542-92e83915f5f8&p=2) The damage to China's position is more subtle. The crisis has not--yet--led to the nightmare scenario

that China-watchers fear: a recession or slowdown producing the kind of social unrest that could challenge the government. That may
still come to pass--the recent economic news from China has been consistently worse than most experts predicted--but, even if the worst case is avoided, the financial crisis has nevertheless had significant effects. For one thing, it has reminded China that its growth remains dependent on the health of the U.S. economy. For another, it has shown that China's modernization is likely to be long, dangerous, and complex rather than fast and sweet, as some assumed. In the lead-up to last summer's Beijing Olympics, talk of a Chinese bid to challenge America's global position reached fever pitch, and the inexorable rise of China is one reason why so many commentators are fretting about the "post-American era." But suggestions that China could grow at, say, 10 percent annually for the next 30 years were already looking premature before the economic downturn. (In late 2007, the World Bank slashed its estimate of China's GDP by 40 percent, citing inaccuracies in the methods used to calculate purchasing power parity.) And the financial crisis makes it certain that China's growth is likely to be much slower during some of those years. Already exports are falling, unemployment is rising, and the Shanghai stock market is down about 60 percent. At the same time, Beijing will have to devote more resources and more attention to stabilizing Chinese society, building a national health care system, providing a social security net, and caring for an aging population, which, thanks to the one-child policy, will need massive help from the government to support itself in old age. Doing so will leave China fewer resources for military build-ups and foreign adventures. As the crisis has forcefully reminded Americans, creating and regulating a functional and flexible financial system is difficult. Every other country in the world has experienced significant financial crises while building such systems, and China is unlikely to be an exception. All this means that China's rise looks increasingly like a gradual process. A deceleration in China's long-term growth rate would postpone indefinitely the date when China could emerge as a peer competitor to the United States. The present global distribution of power could be changing slowly, if at all. The greatest danger both to U.S.-China relations and to American power itself is probably not that China will rise too far, too fast; it is that the current crisis might end China's growth miracle. In the worst-case scenario, the turmoil in the international economy will plunge China into a major economic downturn. The Chinese financial system will implode as loans to both state and private enterprises go bad. Millions or even tens of millions of Chinese will be unemployed in a country without an effective social safety net. The collapse of asset bubbles in the stock and property markets will wipe out the savings of a generation of the Chinese middle class. The political consequences could include dangerous unrest--and a bitter climate of anti-foreign feeling that blames others for China's woes. (Think of Weimar Germany, when both Nazi and communist politicians blamed the West for Germany's economic travails.) Worse, instability could lead to a vicious cycle, as nervous investors moved their money out of the country, further slowing growth and, in turn, fomenting ever-greater bitterness.

Thanks to a generation of rapid economic growth, China has so far been able to manage the stresses and conflicts of modernization and change; nobody knows what will happen if the growth stops. India's future is also a question. Support for global integration is a fairly recent development in India, and many serious Indians remain skeptical of it. While India's 60-year-old democratic system has resisted many shocks, a deep economic recession in a country where mass poverty and even hunger are still major concerns could undermine political order, long-term growth, and India's attitude toward the United States and global economic integration. The violent Naxalite insurrection plaguing a significant swath of the country could get worse; religious extremism among both Hindus and Muslims could further polarize Indian politics; and India's economic miracle could be nipped in the bud. If current market turmoil seriously damaged the performance and prospects of India and China, the current crisis could join the Great Depression in the list of economic events that changed history, even if the recessions in the West are relatively short and mild. The United
States should stand ready to assist Chinese and Indian financial authorities on an emergency basis--and work very hard to help both countries escape or at least weather any economic downturn. It may test the political will of the Obama administration, but the United States must avoid a protectionist response to the economic slowdown. U.S. moves to limit market access for Chinese and Indian producers could poison relations for years. For billions of people in nuclear-armed countries to emerge from this crisis

believing either that the United States was indifferent to their well-being or that it had profited from their distress could damage U.S. foreign policy far more severely than any mistake made by George W. Bush. It's not just the great
powers whose trajectories have been affected by the crash. Lesser powers like Saudi Arabia and Iran also face new constraints. The crisis has strengthened the U.S. position in the Middle East as falling oil prices reduce Iranian influence and increase the dependence of the oil sheikdoms on U.S. protection. Success in Iraq--however late, however undeserved, however limited--had already improved

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the Obama administration's prospects for addressing regional crises. Now, the collapse in oil prices has put the Iranian regime on the defensive. The annual inflation rate rose above 29 percent last September, up from about 17 percent in 2007, according to Iran's Bank Markazi. Economists forecast that Iran's real GDP growth will drop markedly in the coming months as stagnating oil revenues and the continued global economic downturn force the government to rein in its expansionary fiscal policy. All this has weakened Ahmadinejad at home and Iran abroad. Iranian officials must balance the relative merits of support for allies like Hamas, Hezbollah, and Syria against domestic needs, while international sanctions and other diplomatic sticks have been made more painful and Western carrots (like trade opportunities) have become more attractive. Meanwhile, Saudi Arabia and other oil states have become more dependent on the United States for protection against Iran, and they have fewer resources to fund religious extremism as they use diminished oil revenues to support basic domestic spending and development goals. None of this makes the Middle East an easy target for U.S. diplomacy, but thanks in part to the economic crisis, the incoming administration has the chance to try some new ideas and to enter negotiations with Iran (and Syria) from a position of enhanced strength. Every crisis is different, but there seem to be reasons why, over time, financial crises on balance reinforce rather than undermine the world position of the leading capitalist countries. Since capitalism first emerged in early modern Europe, the ability to exploit the advantages of rapid economic development has been a key factor in international competition. Countries that can encourage--or at least allow and sustain--the change, dislocation, upheaval, and pain that capitalism often involves, while providing their tumultuous market societies with appropriate regulatory and legal frameworks, grow swiftly. They produce cutting-edge technologies that translate into military and economic power. They are able to invest in education, making their workforces ever more productive. They typically develop liberal political institutions and cultural norms that value, or at least tolerate, dissent and that allow people of different political and religious viewpoints to collaborate on a vast social project of modernization--and to maintain political stability in the face of accelerating social and economic change. The vast productive capacity of leading capitalist powers gives them the ability to project influence around the world and, to some degree, to remake the world to suit their own interests and preferences. This is what the United Kingdom and the United States have done in past centuries, and what other capitalist powers like France, Germany, and Japan have done to a lesser extent. In these countries, the social forces that support the idea of a competitive market economy within an appropriately liberal legal and political framework are relatively strong. But, in many other countries where capitalism rubs people the wrong way, this is not the case. On either side of the Atlantic, for example, the Latin world is often drawn to anti-capitalist movements and rulers on both the right and the left. Russia, too, has never really taken to capitalism and liberal society--whether during the time of the czars, the commissars, or the post-cold war leaders who so signally failed to build a stable, open system of liberal democratic capitalism even as many former Warsaw Pact nations were making rapid transitions. Partly as a result of these internal cultural pressures, and partly because, in much of the world, capitalism has appeared as an unwelcome interloper, imposed by foreign forces and shaped to fit foreign rather than domestic interests and preferences, many countries are only half-heartedly capitalist. When crisis strikes, they are quick to decide that capitalism is a failure and look for alternatives. So far, such half-hearted experiments not only have failed to work; they have left the societies that have tried them in a progressively worse position, farther behind the front-runners as time goes by. Argentina has lost ground to Chile; Russian development has fallen farther behind that of the Baltic states and Central Europe. Frequently, the crisis has weakened the power of the merchants, industrialists, financiers, and professionals who want to develop a liberal capitalist society integrated into the world. Crisis can also strengthen the hand of religious extremists, populist radicals, or authoritarian traditionalists who are determined to resist liberal capitalist society for a variety of reasons. Meanwhile, the companies and banks based in these societies are often less established and more vulnerable to the consequences of a financial crisis than more established firms in wealthier societies. As a result, developing countries and countries where capitalism has relatively recent and shallow roots tend to suffer greater economic and political damage when crisis strikes--as, inevitably, it does. And, consequently, financial crises often reinforce rather than challenge the global distribution of power and wealth. This may be happening yet again. None of which means that we can just sit back and enjoy the recession. History may suggest that financial crises actually help capitalist great powers maintain their

leads--but it has other, less reassuring messages as well. If financial crises have been a normal part of life during the 300-year rise of the liberal capitalist system under the Anglophone powers, so has war. The wars of the League of Augsburg and the Spanish Succession; the Seven Years War; the American Revolution; the Napoleonic Wars; the two World Wars; the cold war: The list of wars is almost as long as the list of financial crises. Bad economic times can breed wars. Europe was a pretty peaceful place in 1928, but the Depression poisoned German public opinion and helped bring Adolf Hitler to power. If the current crisis turns into a depression, what rough beasts might start slouching toward Moscow, Karachi, Beijing, or New Delhi to be born? The United States may not, yet, decline, but, if we can't get the world economy back on track, we may still have to fight.

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Econ/Hospitals Extension
As the recession continues, hospital programs are cut and residents are forced to repay the differences Gavin Newsome, Mayor of San Francisco, 7-23 (May of San Francisco, 7-29-09, http://www.huffingtonpost.com/gavin-newsom/asolution-to-our-health_b_244057.html)

Health care reform is about the estimated 47 million Americans that do not have health insurance. Nearly five million people have lost their insurance since September 2008. 14,000 more are losing coverage every day -- and the situation is only getting worse. This is not a game. This is a crisis. And as the recession continues, it is a crisis with profound implications for every city and county in America. Earlier this week, Governor Schwarzenegger balanced the California state budget on the backs of local governments, taking $4 billion from cities and counties, slashing $1.3 billion from the state's health care
program for the poor and gutting millions more from the Healthy Families insurance program that provides coverage for children.

What is happening in California is not unique to our state. Mayors and city councils across the country are facing similar problems as state governments slash health coverage to balance their books. Our emergency rooms will bear the brunt of these cuts, as patients will flood our hospitals when they can no longer see a doctor. Our residents will pay the price with higher taxes, more expensive premiums, hidden costs and increased fees. Our cities and towns will all have to pick up the tab. This is a crisis. And our cities and towns are on the front lines. US hospitals are struggling financially as immigrants continue to use emergency services without paying Chelsea Schilling, staff reporter, 1-15, (Word Net Daily, 1-15-09, http://www.wnd.com/index.php?fa=PAGE.view&pageId=8624)3 Rubenstein cites a recent construction boom among the nation's hospitals. As many as 60 percent of America's hospitals are either under construction or have plans for new facilities. "But we have a two-tier hospital system in the U.S. Hospitals in poor areas that serve primarily uninsured immigrants and Medicaid patients cannot afford their facilities," he writes. "The uncompensated costs are killing them. In California, 60 emergency departments (EDs) have closed to avoid the uncompensated costs of their largely illegal alien caseloads." Illegal aliens use emergency rooms more than twice as often as U.S. citizens, and providing their uncompensated care has been the death of many emergency departments. In 2006, more than 46 percent of illegals did not have medical insurance. Although illegal aliens are not supposed to be eligible for Medicaid, they receive Emergency Medicaid and their children are entitled to all benefits that legal immigrants receive. Because hospitals are forced to care for Medicaid recipients, the government program never covers full costs of service. It underpaid hospitals by $11.3 billion in
2006, he wrote.

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Human Rights/ Heg Advantage

Denying Illegal Immigrants access to Healthcare is immoral and destroys U.S. Human Rights Leadership This independently destroys the credibility of International Human Rights Agreements Marietta, Graduate Student,06
(Melissa Marietta, International Social Science Review, 2006, Undocumented Immigrants Should Receive Services,http://www.britannica.com/bps/additionalcontent/18/21409437/UNDOCUMENTED-IMMIGRANTS-SHOULDRECEIVE-SOCIAL-SERVICES [Abhik]) Social

For most Americans, immigration is a volatile and emotional issue. Opinions, rhetoric, and statistics concerning the impact of immigration on the U.S. economy are often hotly debated. One aspect of this debate that is largely ignored is the cultural impact of immigration on American society. Every ethnic group and nationality brings a new perspective, a different behavior, and traditions, all things that one cherishes. In seeking their piece of the American dream, immigrants bring richness and diversity to American culture. They thus improve the quality of life in America. Unfortunately, people cannot make policy on such ideals; instead, they focus on statistics and disregard the culture that enriches their lives. Undocumented immigrants are a growing percentage of the U.S. population, numbering nearly eleven million nationwide. [1] As their numbers grow, so too does the debate as to whether or not they should receive social service benefits provided to American citizens. Some Americans argue that undocumented immigrants should be denied all such services because they do not pay federal taxes; they are "illegal" citizens and a drain on government services and the economy. Denying public services to undocumented immigrants, they claim, will discourage them from entering the country. Such reasoning will not stop unauthorized immigration to the United States. Most immigrants come to the U.S. for better work opportunities and higher wages, not services. According to U.S. Representative Luis Gutierrez (D-IL): Undocumented workers will continue to enter America as long as there are jobs and employers willing to hire them. Congress and state legislatures are hesitant to enact laws which will affect employers adversely. They do not want to upset the business community which understands America's need for these workers and their contribution to the nation's economy. It is therefore hypocritical for U.S. immigration policy to welcome these immigrants to fill labor needs and then refuse to offer them any social services. If undocumented immigrants are denied social services, the quality of health, education, and safety of entire communities will suffer. Providing access to basic services may prevent problems from expanding into something communities cannot ignore and eventually cost more to remedy in the future. Services currently offered to undocumented immigrants include medical care, education, and benefits such as food stamps. Undocumented workers may also qualify for workers' compensation and veterans' benefits. By denying these services

to undocumented immigrants, the United States will simply create another subclass of people in its society. Many of the bills under consideration by various state legislatures seek to deny emergency medical treatment and education to undocumented workers. This violates the Emergency Medical Treatment and Labor Act (1986) which states that any patient cannot be denied emergency medical care based on his/her ability to pay. In addition, the U.S. Supreme Court, in Plyler v Doe (1982), ruled that public
education (K-12) must be provided to all children.[3] With two new U.S. Supreme Court justices, John Roberts and Samuel Alito, many anti-immigrant groups are hoping that this law and court decision will be reversed, but Americans must understand that these services create an educated and healthy populous necessary for the country to prosper. Education is an important social service available to everyone who resides in the United States because the government regards it as the most important credential one can bring to the labor market. The current national shortage of teachers and nurses can be partially remedied by immigrants. Yet, legislation is pending in some states to limit education opportunities for undocumented immigrants and their children. For example, the Georgia General Assembly, during its 2006 legislative session, considered several bills to that effect, including Senate Bill 171 that would require proof of American citizenship to attend state colleges and universities. Another proposal. House Resolution 256, seeks to amend the state Constitution in order to ban all undocumented children from public schools.[4] Bills denying educational opportunity will likely result in an increase in crime and poverty. Many immigrants do not receive needed Healthcare because they fear

deportation. Denying healthcare to any segment of the population can lead to more extreme ailments that become more expensive to treat. Dr. Hogai Nassery, a hysician who practices in Chamblee, GA, states: Reality dictates that millions of undocumented immigrants plan to remain in the United States. Denying them healthcare services will lead to increased instances of infectious, yet treatable diseases. The state legislatures of Georgia
and Oklahoma nonetheless are trying to bar undocumented immigrants from receiving any medical care, including

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emergency room services.[6] This overlooks the fact that most undocumented immigrants in the U.S. are younger workers. Since younger people tend to use less Healthcare than the elderly, healthcare cost estimates for undocumented aliens tend to be exaggerated.[7] The denial of healthcare is not only bad policy, it is unrealistic, cruel, and violates medical ethics. Should an undocumented worker involved in an accident be denied healthcare and left in front of a hospital to die?

Most physicians have ignored the laws and treated patients regardless of their immigration status. America has the moral obligation to care for those who reside here. Americans pride themselves on providing a moral compass for the rest of the world. They believe that every human life is precious and important. Denying any individual healthcare based on citizenship contradicts that belief. In championing the cause of human rights around the world, the United Nations strives to promote equality, freedom, "social progress [,] and better standards of life."[8] As the world's only superpower, the U.S. should be leading by example instead of debating whether or not undocumented immigrants deserve healthcare, education, and other benefits. The United Nations' International Convention on Economic, Social, and Cultural Rights (UNIESCR) is committed to "the prevention, treatment and control of epidemic, endemic, occupational and other diseases and the creation of conditions which would assure to all, medical services and medical attention in the event of sickness." [9] UNICESCR also supports free education for primary school students and the availability of secondary and higher education for everyone. As one of the nations that signed this agreement, the United States should devote itself to the well being of all who reside within its borders.[10] Undocumented immigrants receive services other than simply healthcare and education. They drive on
roads, use public libraries, and use police and fire protection, to name a few. If one tries to deny public services to undocumented immigrants, where does one draw that line? When does one cross the line between enforcing laws that seek to protect and those that discriminate? If a person looks like an immigrant, must their identification be checked before admitting him/her to the hospital? Representative Gutierrez laments: anti-immigrant legislation makes any person who doesn't look "American" an immediate suspect, whether that person is applying for a student loan or Social Security benefits. Almost all of these proposals would turn every local agency, from schools to employment offices, into regulated outposts of the Immigration and Naturalization Service, forcing them to constantly check every applicant's immigration status. (11)

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Plan Reduce Federal Spending

We should include immigrants in health carecounting them in solves hospital overburden and reduces federal spending Ludden, immigration specialist for NPR, 09
(Jennifer Ludden, immigration specialist for NPR, 7/8/2009, <http://www.npr.org/templates/story/story.php?storyId=106376595>)

No proposal for a national health plan would cover the nation's estimated 11 million illegal immigrants. This would
As Congress wrangles with overhauling the health care system, there is one population not being discussed. seem like a big problem, one that could seriously undermine the cost-savings benefit of a program that aims to be universal, but analysts say the notion that illegal immigrants drain the health system is overblown. Simply figuring out how many undocumented immigrants lack insurance is not easy. Foreign-born noncitizens are the fastest growing segment of those without insurance about 20 percent of the nation's estimated 46 million uninsured but surveys don't ask legal status. John Sheils of the Lewin Group, a nonpartisan health care consulting firm owned by UnitedHealth Group, has looked at numerous studies to extrapolate a best guess. " We've estimated about 6.1 million of the uninsured are actually undocumented," Sheils says. That's only about half the total population of undocumented immigrants. Sheils says many illegal immigrants use false documents to work on the books, with regular tax deductions and benefits. "A lot of those people are getting employer health benefits as part of their compensation," Sheils says. A spokesman with America's Health Insurance Plans says it's possible that individual insurance companies could check for legal status, but employerprovided coverage is vetted at the workplace. If a fake ID can get you a job, it can also get your family health insurance. In fact, Sheils says, this is something lawmakers might want to consider as they craft legislation aiming for near-universal coverage. If you design a plan improperly, you actually would wind up taking away their insurance, creating new uninsured people," he says. But what about those illegal immigrants who, today, do not have health insurance? Six million people others estimate 8 million is still a sizeable chunk. So how much health care do they use each year? "The economics aren't as great as they've been made out to be," says Paul Fronstin of the Employee Benefit Research Institute. Fronstin says illegal immigrants are younger, and so generally healthier, than the overall population, and studies show they go to the doctor far less than the native born. He estimates their total share of the health care system at about 1 or 2 percent, with only a small slice of that paid for in public money. About $1 billion a year is paid by Emergency Medicaid, a federal program that covers emergency care for patients who would otherwise be eligible for Medicaid but can't prove their legal status. Sheils estimates that an additional $5 billion is uncompensated in any way. He says that's a blip on the national health care system some two-tenths of 1 percent but it can hurt when it falls disproportionately on hospitals, say, along the southern U.S. border. "Some hospitals have had to cut back services to their community at large because they have to absorb the added costs," says Carla Luggiero of the American Hospital Association. Luggiero has seen more and more hospitals face the burden of caring for illegal immigrants in the past decade. Some have had to raise fees. Others qualify for extra federal subsidies if they have an especially large number of Medicare or Medicaid patients. Luggiero says this can be a way to indirectly cover part of the cost of caring for the undocumented. "So although those programs do not reimburse for the care of undocumented and uninsured individuals," she says, "collectively we as society do end up bearing that cost." Luggiero says if Congress does not

include illegal immigrants in any health plan, hospitals will look for those federal payments to continue. They would also like lawmakers to revive a separate subsidy that reimbursed hospitals several hundred million
dollars for care of the undocumented in recent years but has expired. Peter Harbage of the Center for American Progress says health care for the undocumented is as much a political question as an economic one . No one wants to subsidize primary care for those with no right to be in the country , says Harbage, yet it is accepted that no one is turned away for emergency care. "So there's this very interesting tension," he says. "If some of those dollars were used up front, you could have, maybe, a more efficient system. But that's not the conversation that's being had on Capitol Hill."

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Plan Reduces Federal Spending

Giving Healthcare saves money Gavin Newsome, Mayor of San Francisco, 7-29 (May of San Francisco, 7-29-09, http://www.huffingtonpost.com/gavin-newsom/asolution-to-our-health_b_244057.html)

Health care reform is about the estimated 47 million Americans that do not have health insurance . Nearly five million people have lost their insurance since September 2008. 14,000 more are losing coverage every day -- and the situation is only getting worse. This is not a game. This is a crisis . And as the recession continues, it is a crisis with profound implications for every city and county in America. Earlier this week, Governor Schwarzenegger balanced the California state budget on the backs of local governments, taking $4 billion from cities and
counties, slashing $1.3 billion from the state's health care program for the poor and gutting millions more from the Healthy Families insurance program that provides coverage for children. What is happening in California is not unique to

our state. Mayors and city councils across the country are facing similar problems as state governments slash health coverage to balance their books. Our emergency rooms will bear the brunt of these cuts, as patients will flood our hospitals when they can no longer see a doctor. Our residents will pay the price with higher taxes, more expensive premiums, hidden costs and increased fees. Our cities and towns will all have to pick up the tab. This is a crisis. And our cities and towns are on the front lines.

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Domestic Human Rights Promotion is critical to International HR Leadership Powel, Associate Law Prof., 08
(Catherine, American Constitutional Society, October) http://www.acslaw.org/files/C%20Powell%20Blueprint.pdf [Abhik])

a new Administration takes office in January 2009, it will have an opportunity to reaffirm and strengthen the longstanding commitment of the United States to human rights at home and abroad. This commitment is one that has been expressed throughout U.S. history, by leaders from both parties. In reality, however, when the idea of human rights is discussed in the United States today, more often than not the focus is on the promotion of human rights abroad and not at home. Indeed, human rights has come to be seen as a purely international concern, even though it is fundamentally the responsibility of each nation to guarantee basic rights for its own people, as a matter of domestic policy. Reaffirming and implementing the U.S. commitment to human rights at home is critical for two reasons. First, human rights principles are at the core of Americas founding values, and Americans (as well as others within our borders or in U.S. custody), no less than others around the world, are entitled to the full benefit of these basic guarantees. That can hardly be open to debate. The second reason is perhaps less obvious, but equally compelling. When the United States fails to practice at home what it preaches to others, it loses credibility and undermines its ability to play an effective leadership role in the world. Leading through the power of our example rather than through the example of our power3 is particularly critical now, at a juncture when the United States needs to cultivate international cooperation to address pressing issues such as the current economic downturn that have global dimensions. Perhaps not surprisingly, then, an overwhelming majority of Americans strongly embrace the notion of human rights: that is, the idea that every person has basic rights regardless of whether or not the government recognizes those rights.4Continues Even so, there remains a gap between the human rights ideals that the United States professes and its actual domestic practice, resulting in both a gap in credibility and a weakening of U.S. moral authority to lead by example. Human rights include the right to be free from
As torture or cruel, inhuman or degrading treatment, and yet the United States has committed such acts in the name of counterterrorism efforts. Human rights include the rights to emergency shelter, food, and water, as well as security of person, and yet the United States failed to adequately guarantee these rights in the aftermath of Hurricane Katrina. Human rights include the right to equality of opportunity, and yet inequalities persist in access to housing, education, jobs, and health care. Human rights include the right to equality in the application of law enforcement measures, and yet there are gross racial disparities in the application of the death penalty, and racial and ethnic profiling has been used unfairly to target African Americans, Latinos, and those who appear Arab, Muslim, South Asian, or immigrant (whether through traffic stops, airport screening, or immigration raids). Human rights include the right to equal pay and gender equality, and yet a pay gap persists between female and male workers. Certainly, the journey to fully realizing human rights is a work-in-progress, but to make progress, we must work through smart, principled policies that advance the ability of the United States to live up to its own highest ideals. Thus, January 2009 should mark the beginning of a transition from a society that has condoned torture, cruel interrogation, and inhumane treatment of detained terrorism suspects to a society that deems such conduct unacceptable not only by other nations, but by our own . We should

make the transition from a society that has tolerated little or no access to health care for certain individuals to a society that recognizes access to health care for all as a basic right. We should make the
transition from a society of structural inequality to one in which not only the very highest glass ceilings are broken, but also in which sticky floors and broken ladders to opportunity are repaired. Marking the transition in this way is both principled and in

Americas self-interest.

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Lack of Human Rights makes every impact inevitable Shattuck, Assistant Secretary of State, 94
(John Shattuck, Assistant Secretary of State For Human Rights And Humanitarian Affairs, April 19 th, 1994, Federal News Service, Lexis) I would like to start my testimony, Mr. Chairman, which I will summarize -- obviously, you have an extended statement, and I do apologize for the fact that it arrived perhaps later than it should have -- I'd like to start by offering some brief observations about what it means to advocate human rights and democracy in the post-Cold- War world, which is where we are today, of course. We are confronted by extraordinary changes all around us that are at once profoundly inspiring and deeply disturbing. Alongside a worldwide movement for human rights and democratization, which I think has transformed in many ways the political shape of the globe, we see stirrings of deep cultural and ethnic tensions. The principle of selfdetermination is being pursued and yet is itself a source of very deep human rights questions. These are not academic questions. Around the world we are witnessing ugly and violent racial, ethnic and religious conflict in Bosnia, Central Asia, Africa, most vividly, perhaps, right now in Rwanda, in the Sudan, but elsewhere, too, away from the cameras. The international community clearly has not developed an adequate response to these problems. Why, then, if they are so daunting, has this administration made protecting human rights and promoting democracy a major part of our foreign policy agenda? I think the answer lies not only in our American values but in also the strategic benefits to the United States. We

know from historical experience that democracies are more likely than other forms of government to respect human rights, to settle conflict peacefully, to observe international law and honor agreements, to go to war with great reluctance, and rarely against other democracies, to respect the rights of ethnic, racial and religious minorities living within their borders, and to provide the social and political basis for free market economics. By contrast, Mr. Chairman, the costs to the world of repression and authoritarianism are painfully clear. In the 20th century, the number of people killed by their own governments under authoritarian regimes is four times the number killed in all this century's wars combined. Repression pushes refugees across borders and triggers wars; unaccountable governments are heedless of environmental destruction, and the agenda for repression goes on in a very negative way. These, then, are
the reasons why promoting democracy and human rights are at the forefront of our foreign policy agenda. What are our strategic objectives? In a word, Mr. Chairman, we aim, perhaps not yet successfully, to incorporate human rights and democracy into the mainstream of our foreign policy-making.

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It is our Social Responsibility to give Immigrants Healthcare Dwyer, New York State University Associate Prof., 04
(James Dwyer, PhD, Associate Professor of Bioethics and Humanities and Upstate Medical University, Illegal Immigrants, Health Care and Social Responsibility, The Hastings Center Report, Volume 34, Issue 1, pg. 34, Jan/Feb 2004, http://proquest.umi.com/pqdlink?Ver=1&Exp=07-20-2014&FMT=7&DID=623072201&RQT=309 [Abhik]) But because of their illegal status, undocumented workers are often unable to challenge or report employers who violate even the basic standards of a decent society. We need to take responsibility for preventing the old pattern from continuing, and the key idea is that of "taking responsibility." It is not the same as legal accountability, which leads one to think about determining causation, proving intention or negligence, examining excuses, apportioning blame, and assigning costs. Taking responsibility is more about seeing patterns and problems, examining background conditions, not passing the buck, and responding in appropriate ways. A society need not bear full causal responsibility in order to assume social responsibility. Why should society take responsibility for people it tried to keep out of its territory, for people who are not social members ? Because in many respects illegal immigrants are social members. Although

they are not citizens or legal residents, they may be diligent workers, good neighbors, concerned parents, and active participants in community life. They are workers, involved in complex schemes of social cooperation. Many of the most exploited workers in the industrial revolution-children, women, men without property-were also not full citizens, but they were vulnerable people, doing often undesirable work, for whom society needed to take some responsibility. Undocumented workers' similar role in society is one reason that the social responsibility to care for them is different from the responsibility to care for medical visitors. If a given society had the ethical conviction and political will, it could develop practical measures to transform the worst aspects of some work, empower the most disadvantaged workers, and shape the background conditions in which the labor market operates. The interests of the worstoff citizens and the interests of illegal immigrants need not be opposed. Practical measures may raise labor costs and increase the price of goods and services, as they should. We should not rely on undocumented workers to keep down prices on everything from strawberries to sex.I can already hear the objection. "What you propose is a perfect recipe for increasing illegal immigration. All the practical measures that you suggest would encourage more illegal immigration." Whether improving the situation of the worst-off workers will increase illegal immigration is a complex empirical question. The answer probably depends on many factors. But even if transforming the worst work and empowering the worst-off workers leads to an increase in illegal immigration, countries should take those steps. Although we have a right to regulate immigration, considerations of justice constrain the ways we can pursue that aim. A society might also decrease illegal immigration by decriminalizing the killing of illegal immigrants, but no one thinks that would be a reasonable and ethical social policy. Nor do I think that the old pattern of using marginalized people is a reasonable and ethical way to regulate immigration.

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Restoring HR Leadership is key to restoring soft power, preventing Mexico collapse and the recruitment of educated individuals for the military Schulz, Senior Fellow at the Center for American Progress, 09
(William F. Schultz, Adjunct Professor of International Relations at The New School, June 2009, The Power of Justice, Center for American Progress, http://www.americanprogress.org/issues/2009/06/pdf/humanrights.pdf [Abhik]) It almost goes without saying at this point that the many violations of international law and standards carried out in the name of combating terrorism have done enormous damage to Americas reputation. In 1998, 59 percent of citizens in Great Britain and 61 percent in Germanytwo of the United States staunchest alliessaid America was doing a good job in advancing human rights around the world. By 2006, due to Guantanamo Bay, Abu Ghraib, and other markers of disdain for human rights, those numbers had fallen to 22 percent and 24 percent respectively.32 When Muslims are subjected to racial profiling, such discriminatory treatment makes it easier for Al Qaeda to characterize the United States response to terrorism as a war on Islam. In 2002, for example, the Immigration and Naturalization Service required male visitors to the United States from 25 countriesall of them Arab and Muslim except North Koreato be fingerprinted, photographed, and questioned by authorities. And in 2005 the FBI conducted radiation testing of large numbers of American mosques in the absence of evidence of criminal activity.33 Similarly, just as the Soviet Union once reaped benefits from exploiting the existence of racial discrimination in the United States, so the Chinese have a field day

every year responding to the State Departments criticisms of Chinese human rights abuses by citing American failings. These include the practice of sentencing children to life in prison without parole or the fact that the number of people living in poverty in the United States increased from 36.5 million in 2006 to 37.3 million in 2007. The latter citation indicates that shortcomings in the area of social and economic rights can also have implications for U.S. foreign policy goals. If the United States, for example, recognized a human right to health, it is likely that its approach to the drug wars would focus far more on prevention and treatment than punishment and prison time. That, in turn, would diminish the market for illegal drugs that fuels narcotrafficking, violence on the southern border, and instability in Mexico. Joseph Nye, the renowned coiner of the phrase soft power, has described how an open attitude toward immigration can enhance Americas strategic interests: The fact that people want to come to the United States enhances our appeal America is a magnet, and many people can envision themselves as Americans. Many successful Americans look like people in other countries. Moreover, connections between immigrants and their families and friends back home help to convey accurate and positive information about the United States. In addition, the presence of multiple cultures creates avenues of connection with other countries and helps create a necessary broadening of American attitudes in an era of globalizationit would be a mistake for Americans to reject immigration. Rather than diluting our hard and soft power, it enhances both.34 Conversely, every time an immigrant is treated shabbilywhen, for example, immigrant children or asylum
seekers are incarcerated in punitive conditions or when immigrants in detention are manhandled, held with the general prison population, or denied adequate medical carethe stories of their suffering work their way back to their native lands and diminish the United States in the populations eyes.35 Moreover, as Nye, Thomas Friedman, Leslie Gelb, and many other respected foreign policy analysts have repeatedly pointed out, to stay competitive in a globalized world the United States must rectify shortcomings in its educational system, the exorbitant cost of its health care, and the failure to provide what Friedman has called lifetime employability, which he characterizes not as the guarantee of a lifetime job but the chance to make [oneself] more employable.36This means that addressing social and economic rights to close the achievement gap between well-off children and othersa gap that is above the average for the Organization for Economic Cooperation and Developments 29 industrialized nations is not just a nice idea. It is a matter of national security, as is the need to make health care more affordable or job retraining more accessible in order for dollars and productivity not to be wasted.37 Among other things, failure to improve such conditions makes it harder to find healthy, educationally qualified

recruits for an all-volunteer army that often draws from the lower economic strata of the society. It also

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leaves the United States vulnerable to international economic pressures as President Obama has discovered when
he has tried to convince European nationswhich have far stronger safety nets than the United Statesto join in stimulus spending to end the recession.38 In all these ways and more international human rights standards point the way to a safer, stronger America that is more respected and more economically resilientto say nothing of more just. As President-elect Obama put it in his Human Rights Day statement on December 10, 2008, standing up for

human rights strengthen[s] our security and well-being, because the abuse of human rights can feed many of the global dangers that we confront.39 But if that is the case, then why have Americans and their leaders
been at best indifferent and at times downright hostile to the application of international standards to our domestic practices?

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Plan is key to developing educated recruits for the military Schulz, Senior Fellow at the Center for American Progress, 09
(William F. Schultz, Adjunct Professor of International Relations at The New School, June 2009, The Power of Justice, Center for American Progress, http://www.americanprogress.org/issues/2009/06/pdf/humanrights.pdf [Abhik]) Moreover, as Nye, Thomas Friedman, Leslie Gelb, and many other respected foreign policy analysts have repeatedly pointed out, to stay competitive in a globalized world the United States must rectify shortcomings in its educational system, the exorbitant cost of its health care, and the failure to provide what Friedman has called lifetime employability, which he characterizes not as the guarantee of a lifetime job but the chance to make [oneself] more employable.36This means that addressing social and economic rights to close the achievement gap between well-off children and othersa gap that is above the average for the Organization for Economic Cooperation and Developments 29 industrialized nationsis not just a nice idea. It is a matter of national security, as is the need to make health care more affordable or job retraining more accessible in order for dollars and productivity not to be wasted.37 Among other things, failure to improve such conditions makes it harder to

find healthy, educationally qualified recruits for an all-volunteer army that often draws from the lower economic strata of the society. It also leaves the United States vulnerable to international economic pressures as
President Obama has discovered when he has tried to convince European nationswhich have far stronger safety nets than the United Statesto join in stimulus spending to end the recession.38 In all these ways and more international human

rights standards point the way to a safer, stronger America that is more respected and more economically resilientto say nothing of more just. As President-elect Obama put it in his Human Rights Day statement on December 10, 2008, standing up for human rights strengthen[s] our security and well-being, because the abuse of human rights can feed many of the global dangers that we confront.39 But if that is the case, then
why have Americans and their leaders been at best indifferent and at times downright hostile to the application of international standards to our domestic practices?

Educated Recruits are key to RMA Kapp, Analyst in National Defense, 02

(Lawrence Kapp, Analyst in National Defense Foreign Affairs, Defense, and Trade, February 25, 2002, Recruiting and Retention in the Active Component Military: Are There Problems? CRS Report for Congress) Factor #1: Changing Recruit Quality Needs. Assuming that military personnel requirements (i.e. end strengths) are not significantly increased in future years, and assuming stable retention, the militarys demand for new recruits will not increase significantly over the number of accessions required in FY2001. However, the type of recruit needed may change

dramatically over the next twenty years. Much attention has been paid to the revolution in military affairs (RMA), a military concept based on the premise that the integration of sophisticated information technologies into military operations will transform the way in which the United States fights its wars. Typically,
discussions of RMA center on new types of networked combat systems or on new tactics that can be employed while utilizing these systems. Less frequently mentioned is the type of people who will be required to man these

systems and implement the tactics. They may need to have higher cognitive ability than is presently required, and this could reduce the pool of people qualified to enlist.25 Additionally, as these high cognitive
ability individuals are highly prized by corporations and institutions of higher education, competition for them will be fierce.

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RMA Add-on
RMA is critical to preventing conflicts in global hotspots Diechman, Defense Consultant, 04
(S. J. Deitchman, an independent defense consultant based in Bethesda, Maryland, formerly worked at DOD and the Institute for Defense Analyses. Issues in Science and Technology Online, Completing the Transformation of U.S. Military Forces, Summer 2004, http://www.issues.org/20.4/deitchman.html [Abhik]) Although there have been no arguments about the need to enhance the combat information network and systems, including their intelligence components, there have been extensive arguments about the need for any or all of the new

and advanced aircraft, ships, and ground combat vehicles. The primary objections to the new systems are that they cost too much and are unnecessary now that the United States has no enemies with the military sophistication that the Soviets possessed. But these arguments fail to account for certain realities. First, potential opponents may field formidable armed forces to meet those of the United States. For example, North Korea remains an enigmatic but powerful threat to U.S. interests in the Pacific region. Another example in that area might be a China that, although friendly in a guarded sort of way now, could easily become a military opponent over the issue of Taiwan. That situation can blow up at any time from misunderstanding of the positions of any of the three principals--China, Taiwan, or the United States. Without U.S. fielding of forces obviously able to meet the North Koreans or the Chinese militarily, the growing capabilities of those countries could cause Japan to wonder about the military reliability of the United States as an ally. Although Japan's constitution puts a limit on the growth of the country's offensive military capability, the government could remove that limit if it felt threatened, and Japan has the technological capability to develop advanced weapons, possibly including nuclear weapons. North Korea and China are but two examples of sudden military conflict that might arise in the arc of instability that reaches from North Africa through the Middle East, south and central Asia, all the way to the Korean peninsula. A third example of such a potential opponent arising without much strategic warning could be Pakistan if its government were to fall to the country's Islamist fundamentalist factions. This is not the place to discuss the likelihood of such threats arising,
but we must take note of the potential developments that could evolve into military threats. As has been highlighted above, several of these possible opponents are actively acquiring some of the advanced Soviet-era and more recent systems that can exploit the vulnerabilities of today's U.S. forces. And we must certainly expect that China, with its fast-growing, technology-based economy, will soon be able to field its own versions of such systems. The problem for the United States, then, is to track and maintain superiority over the growing capability of

potential military opponents. Current U.S. military systems are able to match those of such opposition now, but if the United States stands down on advancing its capability, that increasingly precarious balance could change. Worse, it might not realize that the balance had changed until it was already engaged in battle. The argument that if the United States remains alert, it can identify developing threats in time to respond fails to recognize how long it takes to respond. It takes on the order of 10 to 20 years to field
major new military systems. It can take a decade just to field a significant improvement in an existing system, such as a new aircraft or ship radar system. Yet the strategic and military need for such systems could arise in a year or two, or even as a total surprise, as the country learned at Pearl Harbor and feared throughout the Cold War.

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Ext. Mexican Collapse

The Collapse of Mexico will lead to the withdrawal of the U.S. from the international system Haddick, Editor of the Small Arms Journal, 08
Robert Haddick, MBA, Former Director of Research at the Fremont Group, former Marine Corps Officer, his articles have been previously published in prestigious publications such as the New York Post and The Wall Street Journal, Now that would change everything, December 21st 2008, http://westhawk.blogspot.com/2008/12/now-that-would-change-everything.html [Abhik])

There is one dynamic in the literature of weak and failing states that has received relatively little attention, namely the phenomenon of rapid collapse. For the most part, weak and failing states represent chronic, long-term problems that allow for management over sustained periods. The collapse of a state usually comes as a surprise, has a rapid onset, and poses acute problems. The collapse of Yugoslavia into a chaotic tangle of warring nationalities in 1990 suggests how suddenly and catastrophically state collapse can happen - in
this case, a state which had hosted the 1984 Winter Olympics at Sarajevo, and which then quickly became the epicenter of the ensuing civil war. In terms of worst-case scenarios for the Joint Force and indeed the world, two large and important states bear consideration for a rapid and sudden collapse: Pakistan and Mexico. Some forms of collapse in Pakistan would carry with it the likelihood of a sustained violent and bloody civil and sectarian war, an even bigger haven for violent extremists, and the question of what would happen to its nuclear weapons. That perfect storm of uncertainty alone might require the engagement of U.S. and coalition forces into a situation of immense complexity and danger with no guarantee they could gain control of the weapons and with the real possibility that a nuclear weapon might be used. The Mexican possibility may seem less likely, but the government, its politicians, police, and

judicial infrastructure are all under sustained assault and pressure by criminal gangs and drug cartels. How that internal conflict turns out over the next several years will have a major impact on the stability of the Mexican state. Any descent by the Mexico into chaos would demand an American response based on the serious implications for homeland security alone. Yes, the rapid collapse of Mexico would change everything with respect to the global security environment. Such a collapse would have enormous humanitarian, constitutional, economic, cultural, and security implications for the U.S. It would seem the U.S. federal government, indeed American society at large, would have little ability to focus serious attention on much else in the world. The hypothetical collapse of Pakistan is a scenario that has already been well discussed. In the worst case, the U.S. would be able to isolate itself from most effects emanating from south Asia. However, there would be no running from a Mexican collapse.

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Mexican Collapse Heg Collapse

U.S. withdrawal from the international system risks the collapse of the economy, widespread prolif and world war Khalilzad, Counselor at CSIS, 95 (Zalmay Khalilzad, Counselor at the Center for Strategic and International Studies, Former U.S. Ambassador to the
United Nations, Afghanistan and Iraq. Losing the Moment? The United States and the World After the Cold War. The Washington Quarterly, Vol. 18, No. 2. pg. 84 Spring 1995) Realistically and over the longer term, however, a neo-isolationist approach might well increase the danger of major conflict, require a greater U.S. defense effort, threaten world peace, and eventually undermine U.S. prosperity. By withdrawing from Europe and Asia, the United States would deliberately risk weakening the institutions and solidarity of the world's community of democratic powers and so establishing favorable conditions for the spread of disorder and a possible return to conditions similar to those of the first half of the twentieth century. In the 1920s and 1930s, U.S. isolationism had disastrous consequences for world peace. At that time, the United States was but one of several major powers. Now that the United States is the world's preponderant power, the shock of a U.S. withdrawal could be even greater. What might happen to the world if the United States turned inward? Without the United States and the North Atlantic Treaty Organization (NATO), rather than cooperating with each other, the West European nations might compete with each other for domination of East-Central Europe and the Middle East. In Western and Central Europe, Germany -- especially since unification -- would be the natural leading power. Either in cooperation or competition with Russia, Germany might seek influence over the territories located between them. German efforts are likely to be aimed at filling the vacuum, stabilizing the region, and precluding its domination by rival powers. Britain and France fear such a development. Given the strength of democracy in Germany and its preoccupation with absorbing the former East Germany, European concerns about Germany appear exaggerated. But it would be a mistake to assume that U.S. withdrawal could not, in the long run, result in the renationalization of Germany's security policy. The same is also true of Japan. Given a U.S. withdrawal from the world, Japan would have to look after its own security and build up its military capabilities. China, Korea, and the nations of Southeast Asia already fear Japanese hegemony . Without U.S. protection, Japan is likely to increase its military capability dramatically -- to balance the growing Chinese forces and still-significant Russian forces. This could result in arms races, including the possible acquisition by Japan of nuclear weapons. Given Japanese technological prowess, to say nothing of the plutonium stockpile Japan has acquired in the development of its nuclear power industry, it could obviously become a nuclear weapon state relatively quickly, if it should so decide. It could also build long-range missiles and carrier task forces. With the shifting balance of power among Japan, China, Russia, and potential new regional powers such as India, Indonesia, and a united Korea could come

significant risks of preventive or proeruptive war. Similarly, European competition for regional dominance could lead to major wars in Europe or East Asia. If the United States stayed out of such a war -- an unlikely prospect -- Europe or East Asia could become dominated by a hostile power. Such a development would threaten U.S. interests. A power that achieved such dominance would seek to exclude the United States from the area and
threaten its interests-economic and political -- in the region. Besides, with the domination of Europe or East Asia, such a power might seek global hegemony and the United States would face another global Cold War and the risk of a world war

even more catastrophic than the last. In the Persian Gulf, U.S. withdrawal is likely to lead to an intensified struggle for regional domination. Iran and Iraq have, in the past, both sought regional hegemony. Without U.S. protection, the weak oil-rich states of the Gulf Cooperation Council (GCC) would be unlikely to retain their independence. To preclude this development, the Saudis might seek to acquire, perhaps by purchase, their own nuclear weapons. If either Iraq or Iran controlled the region that dominates the world supply of oil, it could gain a significant
capability to damage the U.S. and world economies. Any country that gained hegemony would have vast economic resources at its disposal that could be used to build military capability as well as gain leverage over the United States and other oil importing nations. Hegemony over the Persian Gulf by either Iran or Iraq would bring the rest of the Arab Middle East under its influence and domination because of the shift in the balance of power. Israeli security problems would multiply and the

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increasing the risk of war between the Arabs and the Israelis. The extension of instability, conflict, and hostile hegemony in East Asia, Europe, and the Persian Gulf would harm the economy of the United States even in the unlikely event that it was able to avoid involvement in major wars and conflicts. Higher oil prices would reduce the U.S. standard of living. Turmoil in Asia and Europe would force
major economic readjustment in the United States, perhaps reducing U.S. exports and imports and jeopardizing U.S. investments in these regions. Given that total imports and exports are equal to a quarter of U.S. gross domestic product, the cost of necessary adjustments might be high. The higher level of turmoil in the world would also increase the likelihood of the proliferation of weapons of mass destruction (WMD) and means for their delivery. Already several rogue states such as North Korea and Iran are seeking nuclear weapons and long-range missiles. That danger would only increase if the United States withdrew from the world. The result would be a much more dangerous world

in which many states possessed WMD capabilities; the likelihood of their actual use would increase accordingly. If this happened, the security of every nation in the world, including the United States, would be harmed.

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Soft Power Solves All

Soft Power is key to solving every major impact Stanley, Member of the National Security Advisement Board,07
(Elizabeth Stanley, PhD in Government From Harvard University, Assistant Professor at George Town University, Member of the National Security Advisement Board of Sandia National Laboratories, International perceptions of U.S. Nuclear Policy http://www.prod.sandia.gov/cgibin/techlib/access-control.pl/2007/070903.pdf)

Such reputation effects can have significant impact in terms of gaining international cooperation in addressing global issues that require multilateral solutions and given the interdependent nature of the world today, most issues fall into this category. In contrast to a states hard power (military and economic might), soft power (a states culture, values and institutions) provides an indirect way to influence others. Soft power is an invaluable asset to: (1) keep potential adversaries from gaining international support and winning moderates over to their causes; (2) influence neutral and developing states to support US leadership; and, (3) convince allies to support and share the international security burden. The United States needs soft power assets (including the moral high ground) to solve these problems multilaterally and proactively. For example, one of the wicked problems (problems having complex, adaptive, unpredictable components) that US nuclear policy and posture is trying to address is global proliferation of WMD. Yet, WMD proliferation is not a problem that the United States can address effectively alone. To address global proliferation concerns, the United States needs the rest

of the world to participate in the process. Given how complex the WMD proliferation problem is, this requires not only other international actors to commit to solving the problem with us but that they have a similar understanding of what the problem is. This common problem definition is not possible when the rest of the world has negative perceptions of the United States, when US policies and actions (in the nuclear and non-nuclear
arenas) are perceived as unilateral and hypocritical. Indeed, this paper suggests that many international actors appear to view US policy and actions as one of the contributors to the WMD proliferation problem. In other words, US actions actually affect how other states define the problem, and how they define the problem affects what they believe the right solution is. Given their different understanding, it is not surprising that the wicked problem becomes even thornier to address. In short, how other international actors perceive US policies and actions matters a great deal in their decisions about how much they will cooperate on the US policy goal of non-proliferation. (continued) How important is soft power, anyway? Given its vast conventional military power, does the United States even need soft power? Some analysts argue that US military predominance is

both possible and desirable over the long term, and thus soft power is not important. But a growing consensus disagrees. These analysts argue that soft power is critical for four reasons. First, soft power is invaluable for keeping potential adversaries from gaining international support, for winning the peace in Afghanistan and Iraq, and for convincing moderates to refrain from supporting extremist terrorist groups. Second, soft power helps influence neutral and developing states to support US global leadership. Third, soft power is also important for convincing allies and partners to share the international security burden.14 Finally, and perhaps most importantly, given the increasing interdependence and globalization of the world system, soft power is critical for addressing most security threats the United States faces today. Most global security threats are impossible to be countered by a single state alone. Terrorism, weapons of mass destruction (WMD) proliferation, failed and failing states, conflicts over access to resources, are not confined to any one state. In addition, disease, demographic shifts, environmental degradation and global warming will have negative security implications as well.15 All of these potential threats share four traits: (1) they are best addressed proactively, rather than after they develop into full-blown crises; (2) they require multi-lateral approaches, often under the umbrella of an international institution; (3) they are not candidates for a quick fix, but rather require multi-year, or multi-decade solutions; and, (4) they are wicked problems. Given these four traits, soft power is critical for helping to secure the international, multilateral cooperation that will be necessary to address such threats effectively.

Soft Power Key to Terrorism

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Loss of Soft power results in international terrorism Hamilton, president and director of the Woodrow Wilson International Center for Scholars, 02
(Lee H. Hamilton, chairman and ranking member of the House Committee on Foreign Affairs, 2002, Major U.S. Foreign Policy Challenges, www.wilsoncenter.org/about/director/docs/Hamilton_usfpchall.doc)

Soft power is the capacity to get others to want what you want, without coercing them, because they admire your achievements and want to emulate you. Whether it is our democracy, market-economy, free expression, or technological capabilities, a majority of peoples and countries across the world are moving closer to the American model. So the U.S. currently has no rival in any area of power
This leaves the U.S. with a tremendous amount of soft power. military, economic, or cultural. This is a truly remarkable and unprecedented historical occurrence. Anti-Americanism

American preeminence is viewed with mixed feelings around the world many look up to the U.S. with love, admiration or envy. But American power and American policies have also made the U.S. the worlds largest target for hatred and resentment. Frustrated countries or populations see the U.S. as the source of their hardship and repression, and even our friends and allies are unnerved and often irritated by the extent of American power. This developing anti-Americanism is a growing and serious threat to the security of the U.S. Currently, antiAmericanism takes two distinct forms: the first is hatred in the form of international terrorism, and the second is the developing resentment to U.S. policies across much of the world. 1.Hatred International Terrorism The most immediate threat to American lives and interests is the threat of international terrorism. Causes: International terrorism is caused by a constellation of issues in the Islamic world: political repression, humiliation, economic isolation, and certain elements of U.S. foreign policy contribute to widespread frustration and anti-Americanism. American support for Israel, our
military presence in Saudi Arabia and the Persian Gulf, sanctions on Iraq and plans for regime-change in Baghdad, and our history of intervention in Muslim countries is widely resented and portrayed as the source of all of the ills of the Islamic world from the ineffectiveness of Arab leaders to the suffering of the Palestinian people. The militant ideology of radical Islamic fundamentalism taps into these feelings of anger and desperation to recruit terrorists. What are the consequences of international terrorism?: International terrorism has severe consequences for American citizens and interests, as September 11 catastrophically demonstrated. -1) Terrorism threatens the lives of American citizens, servicemen and women, and diplomats. In recent years, Americans have died at the hands of terrorists on the homeland, in embassy postings, and on military assignments. In the last few weeks alone an American marine has been killed in Kuwait and an American diplomat was assassinated in Amman, Jordan. -- 2) Terrorism threatens vital American political interests around the world. For instance, terrorism in the Middle East threatens the political stability of countries in the region, as well as the worlds energy supply. -- 3) Terrorism threatens global economic stability. In an increasingly globalized world, a terrorist attack can cause a major shock to the U.S. economy, and can badly disrupt regional economic stability and development abroad. The recent terrorist attack in Bali could devastate Indonesias tourism industry a key source of revenue for that country and damage the regional economy.

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Soft Power: Warming/Disease/Environment

Soft Power key to solve warming, disease, and environmental degradation Hamilton, president and director of the Woodrow Wilson International Center for Scholars, 02
(Lee H. Hamilton, chairman and ranking member of the House Committee on Foreign Affairs, 2002, Major U.S. Foreign Policy Challenges, www.wilsoncenter.org/about/director/docs/Hamilton_usfpchall.doc) American power this resentment is more elusive, and harder to quantify. It is not just a trait of a militant ideology or the political fringe it has become part of the mainstream political culture in the capitals of Europe, and is gaining momentum in places like Japan, South Korea and Latin America. Recent elections in Germany and Brazil were often characterized by opposition to American policies, as candidates benefited from declaring their firm opposition to U.S. policies. Causes: This global resentment has two major causes. The first is the American tendency to go it alone in international affairs. Most of our friends and allies feel that international institutions, treaties, and multilateral action best serve global interests and security. They resent it when we reject this multilateral approach, and they also resent the arrogant posture that we sometimes assume in dealing with others. The second cause of global resentment is the extent and use of American military power. Since 9/11, the U.S. has aggressively projected its military power abroad invading Afghanistan, constructing new bases in Central Asia, operating in numerous countries, and threatening regime-change in Iraq. Some are concerned that the U.S. is embarking on a new age of imperialism and military adventurism. Many

of our friends and allies feel that the best hope for peace is to bind the world together through international law and international institutions. They prefer diplomacy to force, engagement to isolation, and are uncomfortable with Americas
military posture. What are the consequences of global resentment: The U.S. should not dismiss this growing resentment to its hegemony and the way it uses power. While it may do little to constrain immediate U.S. policy objectives, this developing form of anti-Americanism is a serious threat to long-term American interests for several reasons: -- 1) Global resentment hinders our ability to obtain support on international security issues. The extended debate about a UN resolution on Iraq indicated the growing international distrust of the United States. Eventually we obtained a resolution, but if the current pattern continues , it will become even harder for the U.S. to gain international support for its initiatives. This could lead to a weakening of international support for the war on terrorism, which depends on international cooperation. -- 2) Global resentment makes it

harder to get cooperation on global issues. Most of the key issues of the twenty-first century will be global in nature environmental degradation, global warming, migration, the drug trade, epidemic diseases. If we alienate our friends and allies, we will be less effective in addressing these problems. -- 3) Global resentment could eventually
produce a coalition to balance or challenge American power. Those of you who study history know that nations and empires rarely maintain the dominance that the U.S. currently enjoys for extended periods of time. So far, no coalition has emerged to balance U.S. power because other nations believe that the U.S. by and large represents their interests. Growing global resentment could change that, and encourage nations to coalesce against the U.S.

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2AC States CP
1. Perm do both. Courts wont overrule the perm because its no longer illegalthats Kullgren. 2. Perm- Do plan and then counterplan 3. Solvency Deficit- Getting rid of the fear of deportation is necessary to solving for our States cant solve fear of deportation- Cross apply the Ku and Matani 08 and Park 04 evidence. a. Cant solve bioterror- that causes extinction- extend Stienbruner 97 b. Cant solve Human Rights- the Obama administration needs take responsibility for its lack of international human rights- thats Powell 08. Additionally, if states do it, it wont be perceived internationally because it wont be a uniform federal policy- this causes nuclear war thats Utgoff 02, and Khalilzad 95 4. Litigation. Its illegal. Hospitals that have given aid under state provision causes litigation. Our first Kullgren card says hospitals who use unauthorized funds causes legal consequences that have empirically deterred hospitals from providing care. 5. Illegal. Using block grant money for undocumented immigrants is prohibited by the welfare reform law. Thats Kullgren. 6. Courts would overturn Immigrants are solely within federal jurisdiction the states cant regulate them Swati Agrawal, Associate, Paul, Weiss, Rifkind, Wharton, & Garrison. B.A. 1992, University of Michigan; J.D. 1995,
Yale Law School, (Trusts Betrayed: The Absent Federal Partner in Immigration Policy, Spring, 1996, San Diego Law Review) The federal government enjoys a preeminent role in regulating domestic matters pertaining to aliens. In fact, it enjoys a freedom to take actions against immigrants - legal as well as illegal - that would likely be held inimical to principles of equal protection if applied to citizens, such as racial minorities. n18 In contrast, state assertions of [*764] power over immigration and alienage classifications are regarded by the courts as highly suspect, requiring review under a strict scrutiny standard. n19 Naturally, the question of federal plenary power over immigration matters has raised many questions regarding the appropriate state role in making policies affecting immigrants within their borders.

7. CP Links to Politics-for states to fund immigrants, they need to receive money from the federal government 8. The counterplan is illegit a. destroys research & education- we do specific research on how states counter plan is illegal, while they can fiat state action which discourages issue specific

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research and discourages education about American government and policies b. no literature base- authors write about how state action is good because they can adapt to their region- no one advocates for the 50 states acting together. c. its utopian- 50 states have never acted together Multiple actor fiat is illegit- The aff only gets one actor, the USFG, and the neg can get advantage off of the unanimous state decision- we dont fiat that everyone is congress has to vote for the plan. 9. No solvency advocate- vote them down a. no literature- impossible to do research because no one writes on behalf of all 50 states. b. no offense- cant read specific offense- if we do they can spike out of it. c. destroys education because no clash over solvency d. limits- they can read any counterplan and claim it solves without reading any evidence

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ATExtra T (PLIPs)
1. Extra T inevitablesocial services are means tested. Even services that were designed for persons living in poverty serve people above the poverty line 2. Predictable groundif we win that most programs are means tested, we win that including more than persons living in poverty is best for research 3. Reasonabilitythey can win T if they can prove that our AFF is unreasonably 4. Lit checksfederally funded programs are not exclusive for persons living in poverty. Common literature means there is no unfair research burden 5. Competing interpretations bad a) Infinitely regressivethe NEG can always read a more limiting interpretation. This makes it impossible for the AFF to be topical. Justifies reasonability. b) Arbitrarytheir ability to choose any definition makes debates about who has a more limiting interpretation and not about substance. That kills debate

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ATExtra T (Social services)

1. Our AFF directly removes the barrier that scares immigrants away from health care. This allows immigrants access to a social service. 2. Medicaid is a social serviceMedicare isnt Econ Ed link, 09
Econ Ed link, 2009, <http://www.econedlink.org/lessons/index.php?lesson=190&page=teacher>) Who are the beneficiaries of Medicare and who are the beneficiaries of Medicaid? What is the difference? [Medicare provides health care coverage for 40 million elderly. Medicaid provides health care for 34 million poor people, people with disabilities, and seniors in nursing homes. Medicare is an entitlement. Medicaid is a social service.]

3. Changing the law is a social service?? 4. Changing eligibility requirements is a pre-requisite to social service. Immigrants still wouldnt go see doctors even if states paid for their visits. Our plan changes the way that immigrants perceive health care benefits. Removing the fear of deportation allows them to become integrated into our society so they can get access to other social services. 5. Extra T inevitableits not the AFFs fault that predictable programs have laws that we need to get rid of before we can increase social services 6. Extra T good a) Groundthey get more ground to social services DAs and mek CP b) Educationsmall extra topical planks allow for a lot more education on the topic c) Real worldgovernment action never happens without extra planks 7. The goal of social service agencies to immigrants is to help immigrants integrate Arrighi and Maume, professors of sociology and University of Cincinnati, 07
(Barbara A. Arrighi, David J. Maume, 5/30/2007, professors of Sociology and University of Cincinnati, Child Poverty in America Today: Health and Medical Care Volume II p. 130) Census 2000 indicates that one of four people in the United States was born outside its borders, with substantial numbers having entered after the liberalization of immigration laws in 1965, consequently, U.S. society is becoming increasingly aware of ethnic and cultural differences between immigrants, particularly those of color and the nativeborn populations. Interest in understanding attitudes, values, religions, and behaviors is reflected in the burgeoning literature on immigrants and refugees. Social service agencies have often had to mediate between immigrants and the U.S. institutions as newcomers learn to adapt to their new environments. In this process, the environment has begun to become sensitized to the diversity of the new arrivals.

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ATSubsets T
1. We meetextending immigrants to health care increases the number of patients and cases of disease infection which overall increases quality of medicine which affects everyone. 2. No cases meetno government policies affect everyone a) Real worldeffective policies are tailored to target sub-groups b) Kills debatelimiting out all real world policies makes stale debates and creates a huge research burden. c) OverlimitsOnly universal health care or give everyone education is topical. 3. Infinitely regressivethey can always draw a line broad enough so the group we target will be a subset 4. Social services target sub-groups
CARD

5. Groundmore subsets mean more ground for mechanism CPs and DAs 6. ReasonabilityStates CP, advantages and the word substantially check AFFs 7. Better to have subsets on the AFFthe NEG can always read PICs or generic DAs. The AFF should be allowed leeway.

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ATT: PLIPs
1. We meetincreasing social services to subsets is topical because it results in an overall increase to persons living in poverty 2. Illegal immigrants are in poverty AP, 09
(Associated Press, Illegal immigrants' kids more likely to be poor, 4/15/2009, < http://www.venturacountystar.com/news/2009/apr/15/illegal-immigrants-kids-more-likely-to-be-poor/>) WASHINGTON Growing numbers of children of illegal immigrants are being born in this country, and they are nearly twice as likely to live in poverty as those with American-born parents, an independent research group says. The study released Tuesday by the Pew Hispanic Center highlights a growing dilemma in the immigration debate: Illegal

immigrants children born in the United States are American citizens, yet they struggle in poverty and uncertainty along with parents who fear deportation, toil largely in low-wage jobs and face layoffs in an ailing economy. The analysis by Pew, a nonpartisan research organization, estimated that 11.9 million illegal immigrants lived in the U.S. as of March 2008. Of those, 8.3 million, or 5.4 percent of the U.S. labor force, worked primarily in lower-paying farm, construction or janitorial work. Roughly three out of four of their children or 4 million were
born in the U.S. In 2003, 2.7 million children of illegal immigrants, or 63 percent, were born in this country. Overall, illegal immigrants children account for one of every 15 students in kindergarten through 12th grade.

3. Limitswe limit the AFF to a subset of persons in poverty. That limits the AFF to advantages based on mechanisms specific to immigrants. Thats key to limit the topic. 4. Predictable groundwe open up more ground for specific immigrant targeting mechanisms

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ATT: Citizens only

1. We meetour AFF doesnt target groups specifically. It only allows immigrants to benefit if they choose to 2. In means physically inside Merriam Webster Online, 09
Merriam Webster Online, 2009 <http://www.merriam-webster.com/dictionary/in%5B1%5D>

In: used as a function word to indicate inclusion, location, or position within limits 3. More limitingunder their interpretation, we will have to target businessmen on oversea trips because they are citizens. 4. in the US modifies social services not the persons living in poverty. This is better limits because social services offered by the US could only help persons in the US, but other countries can help persons living in poverty in the US. 5. Citizens only mentality drives securitizing logic. The policies used to deny health care to immigrants has been used to keep them marginalized in society.

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ATImmigration DA
1. Immigration high now 2. Immigration inevitable AP, 07
(Associated Press, Caldern: Immigration is a natural phenomenon, 9/27/2007, <http://www.tucsoncitizen.com/daily/local/64282.php>)

Mexican President Felipe Caldern told U.S. governors Thursday that immigration is an inevitable, natural phenomenon and he urged the U.S. Congress to approve reforms that would allow more Mexicans to work legally north of the border. Caldern demanded the United States respect "the right to work wherever one can make the greatest contribution." "Immigration is a natural phenomenon that is economically and socially inevitable," he told the meeting in this Sonora seaside resort town. In a rare acknowledgment of the costs of migration for Mexico, Caldern said his country "doesn't celebrate migration . . . our best people are the ones who go." Immigration and border security were among the top issues at the meeting, the 25th
PUERTO PEASCO, Son. annual such event between Mexican and U.S. governors from states along the two countries' common border. Mexican officials were focused on stopping the illegal flow of U.S. weapons into Mexico and protesting expansion of U.S. border fencing. For the Americans, the drug trade, migration and border security topped the list. On Monday, the U.S. government announced plans to erect about 370 miles of fencig and 200 miles of vehicle barriers by the end of 2008. Tension over the fences - which have drawn criticism from environmentalists, land owners and politicians in both countries - surfaced at the meeting. "This is the great tragedy," said Carlos de la Parra, a participant in the conference's environmental panel, as he pointed to a map of proposed border fences separating nature reserves. Mentioning a list of wildlife that migrates across the border, Parra, of Mexico's Colegio de la Frontera, noted "these animals don't cross the border to shop. They do it out of necessity." California Gov. Arnold Schwarzenegger, who has opposed the border fencing, praised Mexico and its cooperation with its northern neighbor.

3. Soft power solves the DA impacts 4. Immigration is good a) Immigrants key to offset baby-boomers
Marietta, writer for Social Science Review, 06 (Melissa Marietta, International Social Science Review, Spring-Summer, 2006, http://findarticles.com/p/articles/mi_m0IMR/is_12_81/ai_n16599310/pg_4/?tag=content;col1)

As the "baby-boomers" begin to retire, Social Security will need to be supported by immigrant workers for the U.S. government to meet the retirement needs of its citizens. People, capital, and technology are vital components for sustaining a growing economy. (16) If the U.S. continues to embrace policies that prevent people from entering the country while the current population fails to replenish itself there will not be enough resources to maintain a prosperous economy. The National Research Council has found that "immigration benefits the U.S. economy overall, and has little negative effect on the income and job opportunities of most native-born Americans." (17) It asserts that "immigrants add as much as $ 10 billion to the economy each year and they will pay more in taxes than they use in government services over their lifetimes ." (18)
Jeffery Passel, the author of several studies on immigration, adds "that all immigrants arriving after 1970 pay a total of $70 billion in taxes to all levels of government, thereby generating $25-$30 billion more than they use in public services." (19) As consumers, immigrants buy cars, cell phones, food, clothing, and many other household items. To be sure, they send money to their families left behind in their native countries. Although this may reduce their purchasing power, they still generate millions of dollars into the American economy and tax base. The money they contribute to the American economy is recognized by businesses which continuously reach out to immigrant markets. Representative Gutierrez believes that, "the intolerance we see today is grounded in real problems, [such as] eroding tax bases, budget deficits, increasing crime and the difficulty of controlling our borders." (20) Failure to provide benefits to

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undocumented immigrants is not the solution and searching for scapegoats among those who are unable to defend themselves will not erase real problems. Immigrants pay taxes, contribute to society culturally, and have
demonstrated their willingness to engage in hard work. They may or may not have documents, but their contributions to American society cannot be denied. Congress is currently discussing the Secure America and Orderly Immigration Act of 2005. This bipartisan bill, sponsored by Senators John McCain (R-AZ) and Edward Kennedy (D-MA), addresses issues

such as border security, a worker-visa program, access to healthcare, and the elimination of immigration fraud. (21) This legislation, in seeking a humane and realistic solution to these problems, will help reduce the paranoia
against unauthorized immigration. Hopefully, it will also help Americans understand that immigrants have and will continue to benefit the United States.

b) Financial markets will panic within ten years over the social security crisis unless we have a solution
Nicklaus, business columnist, 06 David Nicklaus, St. Louis Post-Dispatch (Missouri), May 3, 2006, <http://www.vindy.com/news/2006/may/06/how-he-sees-it-socialsecurity-crisis-looms/?print>) The latest report from the Social Security trustees is chock-full of numbers and dates, but most people seem to have focused on a single year: 2040. That's when the system is projected to run out of money an alarming thought, to be sure, but a distant one. With the problem 34 years in the future, politicians can easily pretend that it doesn't exist. Unfortunately, 2040 will be far too late to avoid a crisis. The Medicare trust fund will run out of money in 2018, according to the trustees' projections. Speaking as someone who would become Medicare-eligible just three years later, I think the problem is becoming urgent. In fact, we need to act long before the insolvency dates arrive.

"The government is going to have a cash-flow crisis long before the Social Security trust fund is empty," said Rudolph Penner, a senior fellow with the Urban Institute in Washington. Penner's pick for a red-letter date would be 2011, when the oldest baby boomers become eligible for Medicare. (Some of them will start collecting Social Security just two years from now, when they reach age 62.) "Shortly after that, you begin to see a dramatic acceleration in spending," Penner said. "I don't know at what point financial markets will become really concerned, but it will certainly be long before 2040. Based on the European experience, maybe in 10 years and certainly in less than 15 years people will start to lose confidence in our public debt unless we do something about these programs." Italy and Sweden, for example, faced financial-market panics before they fixed their retirement
problems in the 1990s.

c) We need to attract more immigrants to integrate them into our education systemthis provides a skilled work force that can supply Social Security
Newman, VP of National Lawyers Guild, 01 Nathan Newman, 2001 (longtime union and community activist, a National Vice President of the National Lawyers Guild October 01, 2001, http://www.nathannewman.org/archives/000054.shtml) The Trustees assume that in the next 40 years, the United States will add only 32 million new people of working age, but will add 40 million new retirees. Given the far-ranging needs of retirees, from health care to building new homes, we can comfortably expect that those scarce new workers will have to spend all their time just servicing these basic needs of that retired population. No additional artists, no additional software programmers, no new achievements as a nation; just a massive labor shortage sucking workers into daily care of the aging. In a world sea of willing immigrant workers, it would be fiscal and, frankly, national suicide to slowly convert our present economy into a national copy of Fort Lauderdale. But it won't happen. Increasing immigration by only 200,000 to 300,000 people per year will not only make social security solvent for this century, it will assure that the country will remain a vital, productive nation. Add in the productive power of many retirees who will continue to contribute to the economy as their health is extended, any talk of crisis is ridiculous and merely a con game by Wall Street to grab control of social security asses. Since we don't have a labor shortage now and need to aim to have new immigrants enter the workforce around 2015, immigrants with young children are the ideal for

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today. Some might argue for avoiding any increased immigration until we start breaking even on social security taxes and
payments, but depending purely on mostly unskilled adult immigration in the future makes less sense than encouraging new immigrant children who can be educated and trained in US schools. For long-term sustainable growth in the

economy, this kind of investment in educating immigrant youth for maximum productivity makes more sense than the frenzied mattress- stuffing of the Social Security "crisis" mongers. Now, as the present reactions against immigration show, it will no doubt take some time to push for the broadened immigration needed for the future survival of our retirement system. Still, despite the anti-immigrant hysteria, studies such as
those by Michael Fix and Jeffrey S. Passel show that annual taxes paid by immigrants to all levels of governments more than offset the costs of services they receive, generating a net annual surplus of $25 billion to $30 billion.

d) A collapse of the US economy will escalate to nuclear war.

Cook, Former US Treasury analyst, 07 Richard Cook, Former Analyst in the US Treasury Department, 7 (http://www.globalresearch.ca/index.php?context=va&aid=5964) Times of economic crisis produce international tension and politicians tend to go to war rather than face the economic music. The classic example is the worldwide depression of the 1930s leading to World War II. Conditions in the coming years could be as bad as they were then. We could have a really big war if the U.S. decides once and for all to haul off and let China, or whomever, have it in the chops. If they dont want our dollars or our debt any more, how about a few nukes?

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ATUniversal health care CP

1. Perm do both. Repealing the law to allow immigrants to feel comfortable with the system and giving everyone health care solves the AFF. 2. Normal meanshealth care doesnt include illegal immigrants Montopoli, reporter, 7/21
Brian Montopoli, Reporter for CBS, 7/21/2009, Obama: No Health care for immigrants, <http://www.cbsnews.com/stories/2005/08/30/misc/main806205.shtml> Asked by CBS News' Katie Couric in an exclusive interview whether illegal immigrants should be covered under a new health care plan, President Obama responded simply, "no." But he said there may need to be an exception to that policy for children. "First of all, I'd like to create a situation where we're dealing with illegal immigration, so that we don't have illegal immigrants," he said. "And we've got legal residents or citizens who are eligible for the plan. And I want a comprehensive immigration plan that creates a pathway to achieve that." "The one exception that I think has to be discussed is how are we treating children," he continued. "Partly because if you've got children who may be here illegally but are still in playgrounds or at schools, and potentially are passing on illnesses and communicable diseases, that aren't getting vaccinated, that I think is a situation where you may have to make an exception."

3. Cant solve advantagesonly removing the law and normalizing citizens result in an increase in the number of immigrants using health care. Even if they include immigrants, they cant solve deportation

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4. Perm do the both and expand health care to immigrants. We should include immigrants in health care counting them in solves hospital overburden and reduces federal spending Ludden, immigration specialist for NPR, 09
(Jennifer Ludden, immigration specialist for NPR, 7/8/2009, <http://www.npr.org/templates/story/story.php?storyId=106376595>)

No proposal for a national health plan would cover the nation's estimated 11 million illegal immigrants. This would
As Congress wrangles with overhauling the health care system, there is one population not being discussed. seem like a big problem, one that could seriously undermine the cost-savings benefit of a program that aims to be universal, but analysts say the notion that illegal immigrants drain the health system is overblown. Simply figuring out how many undocumented immigrants lack insurance is not easy. Foreign-born noncitizens are the fastest growing segment of those without insurance about 20 percent of the nation's estimated 46 million uninsured but surveys don't ask legal status. John Sheils of the Lewin Group, a nonpartisan health care consulting firm owned by UnitedHealth Group, has looked at numerous studies to extrapolate a best guess. " We've estimated about 6.1 million of the uninsured are actually undocumented," Sheils says. That's only about half the total population of undocumented immigrants. Sheils says many illegal immigrants use false documents to work on the books, with regular tax deductions and benefits. "A lot of those people are getting employer health benefits as part of their compensation," Sheils says. A spokesman with America's Health Insurance Plans says it's possible that individual insurance companies could check for legal status, but employerprovided coverage is vetted at the workplace. If a fake ID can get you a job, it can also get your family health insurance. In fact, Sheils says, this is something lawmakers might want to consider as they craft legislation aiming for near-universal coverage. If you design a plan improperly, you actually would wind up taking away their insurance, creating new uninsured people," he says. But what about those illegal immigrants who, today, do not have health insurance? Six million people others estimate 8 million is still a sizeable chunk. So how much health care do they use each year? "The economics aren't as great as they've been made out to be," says Paul Fronstin of the Employee Benefit Research Institute. Fronstin says illegal immigrants are younger, and so generally healthier, than the overall population, and studies show they go to the doctor far less than the native born. He estimates their total share of the health care system at about 1 or 2 percent, with only a small slice of that paid for in public money. About $1 billion a year is paid by Emergency Medicaid, a federal program that covers emergency care for patients who would otherwise be eligible for Medicaid but can't prove their legal status. Sheils estimates that an additional $5 billion is uncompensated in any way. He says that's a blip on the national health care system some two-tenths of 1 percent but it can hurt when it falls disproportionately on hospitals, say, along the southern U.S. border. "Some hospitals have had to cut back services to their community at large because they have to absorb the added costs," says Carla Luggiero of the American Hospital Association. Luggiero has seen more and more hospitals face the burden of caring for illegal immigrants in the past decade. Some have had to raise fees. Others qualify for extra federal subsidies if they have an especially large number of Medicare or Medicaid patients. Luggiero says this can be a way to indirectly cover part of the cost of caring for the undocumented. "So although those programs do not reimburse for the care of undocumented and uninsured individuals," she says, "collectively we as society do end up bearing that cost." Luggiero says if Congress does not

include illegal immigrants in any health plan, hospitals will look for those federal payments to continue. They would also like lawmakers to revive a separate subsidy that reimbursed hospitals several hundred million
dollars for care of the undocumented in recent years but has expired. Peter Harbage of the Center for American Progress says health care for the undocumented is as much a political question as an economic one . No one wants to subsidize primary care for those with no right to be in the country , says Harbage, yet it is accepted that no one is turned away for emergency care. "So there's this very interesting tension," he says. "If some of those dollars were used up front, you could have, maybe, a more efficient system. But that's not the conversation that's being had on Capitol Hill."

5. The CP gives health care to everyone including immigrants. That includes normal means of getting rid of any legislative barrier. PICs are bad a) Steals AFF groundusing 1AC ground to weight against case unfairly strips AFF pre-round prep and ground because we cant turn our own case b) Encourages vague plan writinggeneric PICs cause 2AC clarifications. Killing specific NEG strats and

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clash c) Justifies intrinsic permsPICs are intrinsic and we should be able to perm the same way. Any reason intrinsic perms are illegit are reasons to reject the PIC

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2AC: Fiscal D
1. Social Service and military spending coming now Taylor, Associated Press Writer, 7-25
(Andrew Taylor, Associated Press Writer, 7-25-09, http://hosted.ap.org/dynamic/stories/U/US_CONGRESS_SPENDING?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT) WASHINGTON Supporters of government subsidies to help the poor with their heating bills and small towns get clean water used to have to scratch and claw to stave off former President George W. Bush's budget cuts. Not any more.

Democrats now fully in charge in Washington are reshaping the budget landscape, raising Cabinet agencies' budgets by an average 8 percent next year, with domestic programs long favored by Democrats faring better than defense. In a steady march through the summer, the House has passed bill after bill cementing big spending increases for programs Democrats felt were neglected by Bush and Republicans when they ran Congress. The last of them a $730.5 billion measure for labor, education and health programs, including benefit distributors like Medicare and Medicaid was passed Friday by the House. The spending increases for non-defense programs under the dozen House-passed spending bills passed average 11 percent, according to calculations by the GOP staff of the Appropriations Committee. That's on top of generous increases earlier this year. The military, which fared well under Bush and GOP control of Congress , is getting a more modest 4 percent increase. All told, Congress will dole out $1.2 trillion through the 12 appropriations bills, including about $130 billion for U.S. operations in Iraq and Afghanistan. 2. Including the number of immigrants that have access to health care increase reduces strain on hospitals steal federal funding Ludden, immigration specialist for NPR, 09
(Jennifer Ludden, immigration specialist for NPR, 7/8/2009, <http://www.npr.org/templates/story/story.php?storyId=106376595>) Luggiero has seen more and more hospitals face the burden of caring for illegal immigrants in the past decade. Some have had to raise fees. Others qualify for extra federal subsidies if they have an especially large number of Medicare or Medicaid patients. Luggiero says this can be a way to indirectly cover part of the cost of caring for the undocumented. "So although those programs do not reimburse for the care of undocumented and uninsured individuals," she says, "collectively we as society do end up bearing that cost." Luggiero says if Congress does not include illegal immigrants in any health plan, hospitals will look for those federal payments to continue. They would also like lawmakers to revive a separate subsidy that reimbursed hospitals several hundred million dollars for care of the undocumented in recent years but has expired. Peter Harbage of the Center for American Progress says health care for the undocumented is as much a political question as an economic one. No one wants to subsidize primary care for those with no right to be in the country, says Harbage, yet it is accepted that no one is turned away for emergency care. "So there's this very interesting tension," he says. "If some of those dollars were used up front, you could have, maybe, a more efficient system. But that's not the conversation that's being had on Capitol Hill."

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2AC: Fiscal D
3. Lack of preventive healthcare costs much more money in the long run Park, Associate of Troutman Sanders LLP, 04
(Seam, J.D., Substantial Barriers in Illegal Immigrant Access to Publicly-Funded Health Care: Reasons and Recommendations for Change, Georgetown Immigration Law Journal, Volume 18, Issue 3, Spring 2004, Lexis, [Abhik])

Economic inefficiency is another problem with the current legislation. 83 The Welfare Reform Act denies illegal immigrants access to preventive care, but provides that public health care facilities are required to treat emergency conditions for all people, regardless of their immigration status or their ability to pay. The
current legislation, therefore, takes a back-end approach to providing illegal immigrants health care access by providing emergency services. However, this approach is critically flawed because it is more expensive to provide emergency care than it is to take a front-end approach by providing preventive care. 85 Dissenters of taking a front-end approach dispute that providing emergency care would be more costly than providing preventive care and claim that preventive care drains local resources that would be better used serving the documented population. 86 However, these dissenters fail to realize that emergency treatment can cost nearly "four to ten times as much" as providing

preventive care. The cost discrepancy exists because it costs less for health facilities to treat symptoms and conditions before they "degenerate into emergencies that necessitate more elaborate procedures and care," which could include much more expensive services such as intensive care and hospitalization. 89 Doctors and other health care officials have expressed similar concerns. 90 One doctor commented, "It's been our view that from a good public health policy perspective, we would provide preventive care so as to avoid the higher cost of emergency cost and hospitalization, which we would be forced to provide." 91 Adding to
the economic inefficiency of the Welfare Reform Act is the Immigration Reform Law, which does not allow states to provide security against potential deportation if illegal immigrants decide to access the available emergency care. Illegal immigrants must, therefore, fear the possibility of having their immigration status reported to the INS and risk subsequent deportation if they choose to access available emergency care. Thus, illegal immigrants are unlikely to access treatment for emergency [*582] services until they are "supersick" 92 because they risk having their immigration status reported to the INS. This risk arguably places illegal immigrants in a dilemma where their condition might already qualify as an emergency condition, but because of the significant risk involved in seeking the available treatment, they

may undesirably choose to wait until their conditions worsen and degenerate into an even more complicated situation. At which time, conditions may require much more complicated and expensive procedures or treatment. The same legislation is also economically inefficient when considering the cost discrepancy
between treating an outbreak of infectious diseases against providing illegal immigrants with preventive treatment, which lessens the likelihood of the infection and subsequent spread of communicable diseases. 93 As discussed earlier, the illegal immigrant population, because of their often poor, and less than ideal living situation, is at a much greater risk for the infection and transmission of infectious diseases. 94 The same problem with the back-end approach, comprised of strictly providing emergency services, applies in the context of infectious diseases because it is less costly to "prevent infectious diseases . . . early-on than to wait until the acute stage and risk exposure to the general community." 95 Experts have expressed similar concerns. Professor Linda Bosniak stated that, "people afraid to go to the doctor will simply

create the conditions for a public health catastrophe and will end up costing the state more money later on." 96 4. No Link- Plan only makes immigrants eligible for healthcare plan itself doesnt spend any money.

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2AC: Fiscal D
5. Zero risk of econ collapse- its too resilient and public will prevent it Galakoutis, international taxation advisor, 7-24
(Christopher G. Galakoutis, business degree from Concordia University in Montreal, 7-24-09, http://news.goldseek.com/GoldSeek/1248450836.php)

Tens of millions of Americans had to be integrated back into a peacetime economy following World War II. America and its finest companies understood the importance of investing for their collective futures, and by the 1950s, that social contract and the investment it provided helped launch one of the greatest booms in history, where America's industrial might was at its peak. In a real sense, the US became one of the richest, most prosperous nations in history during that time. It was a creditor nation, had a powerful currency backed by gold, and was the envy of the world. For producing the highest quality products that were in high demand worldwide, from cars to television sets, American workers earned the highest wages in the world; real purchasing power that was the springboard for millions to realize their own American Dream. By the 1970s, that had all changed. Excessive spending, a trade imbalance that began in the late 1960s and growing indebtedness forced President Richard Nixon to cut the dollar-gold link on August 15, 1971. The inflation genie was out of the bottle, with the US mired in inflation induced bubbles ever since. Inflation, naturally, increases input
costs for corporations and eats away at consumer purchasing power, putting a dent into the consumer pocketbooks that corporations need for their very survival. No stone was left unturned in the search for continued consumption. Exceptions became the rule, as both parents were eventually forced out into the workplace not only for lifestyle maintenance, but also just to make ends meet. The off shoring of jobs and production was meant to further counter-act the forces chipping away at purchasing power. Off shoring had

the desired effect of bringing retail prices down so that Americans could continue spending. The hollowing out of entire industries and growing unemployment, much like an engine running on less than its allotted cylinders, can only go unnoticed for so long. Consequently, the steadily rising costs for lifes necessities , with no commensurate rise in real wages, meant the shortfall had to be, and was, plugged by easy credit, which banks were only too happy to provide for a remarkably resilient modern US economy. But the combination of continued off shoring, rising unemployment and a collapsed housing market saw that modern economy hit a wall in 2008; its resilience, built on nothing more than a foundation of perpetual bubbles, exposed to have been as credible as a colorful late night infomercial. That said, lets understand one thing before proceeding to discuss the tough choices confronting the country. Despite
deficit and debt troubles that began almost 40 years ago, the US has continued to be the worlds leader in innovation and ideas, a testament to the ingenuity of American business and its long tradition of excellence. Such traditions do not evaporate simply due to temporary trade winds, nor can countries, mired in bubbles themselves or who attained wealth via accidents of geography or by being a factory to the world, easily assume them (a perfect example is the Japanese economic miracle that petered out under the weight of its huge twin bubbles 20 years ago). American economic leadership, despite its current travails, is here to stay -- what we have witnessed the last few months is not only a world that knows this, but one that apparently wants it as well, which is why, in our opinion, the US will NOT head down the hyperinflationary road of Argentina or Zimbabwe. That is not to say there wont be high inflation in the US in the years ahead -- that cake has already been baked. It is why we have been advising readers to buy gold as well as precious metal stocks, and have been critical of US economic policies of recent years . In the months ahead, we believe the US dollar will be managed down in value, which will help bring jobs back to the US for the millions who so desperately need them. Money printing will find its way into the stock market, as it always does, and pull those investors afraid to be left behind back in, with rising valuations helping to repair balance sheets. Those who can will pay down debt this time around. Inflation, however, is no panacea. While it will lessen the debt burdens of the US government and certain consumers, the decline in living standards and loss of purchasing power will hurt those Americans who will be in no position to benefit from it. Those with little to invest but with large debt and/or mortgage balances will continue to be squeezed, prolonging the foreclosure crisis. In addition, unlike prior inflations, workers will be in no position to demand salary increases. Yet the falling currency will continue to push up costs the worst of all worlds for the average middle-class worker! At some point there will be a policy shift when is not knowable given the tremendous forces pulling and tugging from every direction. But a point is inevitably reached where public outcries over the direction a

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country is going, coincident with dangerously high inflation levels, force governments hand. Asset prices will only deflate during
that period, in the true sense of the word deflation, as a designed money supply contraction will reverse the currency decline. At that point, those who managed to avoid financial ruin will pick up assets on the cheap. Also at that time, the US will work with its creditors and negotiate new debt repayment terms. Given the in-your-face realities of that time, taxes and government will have to be cut, in a big way, across the board. A more humble foreign policy will have to be pursued, saving hundreds of billions of dollars. The required changes will be many, and necessary to save the currency. The American people will have to demand them. We saw inklings of that recently with the tea parties in line with such thinking. Fodder they might have been for certain elements we do not agree with, but the general theme of less government we do agree with. The fact Americans finally stood up and did something must have also brought smiles to the nervous faces of our foreign creditors.

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Politics: Plan Bipart

Healthcare is bipartisan- child bill proves
Pear, NY Times Reporter, 09 (Robert, Pear, reporter for NY Times, 1-4-09, http://www.nytimes.com/2009/01/14/world/americas/14iht-15healthcare.19369415.html) With enthusiastic support from President-elect Barack Obama, the House on Wednesday passed a bill to expand the Children's Health Insurance Program. President George W. Bush twice had vetoed similar legislation. Obama will probably be able to sign the bill within days of taking office on Tuesday. The Senate might take action within a week. The House vote was 289 to 139. Supporters never mustered more than 273 votes for similar legislation in the last two years . The bill,

which would extend coverage to four million uninsured children, symbolizes the shift in priorities in Washington.
The vote came five days after the House, defying a veto threat from Bush, passed two bills to combat sex discrimination by employers who pay women less than men doing the same or substantially similar work. The child health bill would provide $32.3

billion over four and a half years to continue coverage for seven million children who now rely on the program and to extend coverage to more than four million who are uninsured. "This is a day of triumph for America's children,"
Speaker Nancy Pelosi of California said. "We put women and children first." After years of frustration, Democrats were exultant. "Today is a new day," Representative Dave Loebsack of Iowa. Representative Chris Van Hollen, Democrat of Maryland, said, "Passing this bill sends a very important signal that change has come to Washington as a result of the last election." Representative Frank Pallone, Democrat of New Jersey, said the bill was a down payment on Obama's promise to make health insurance available to all Americans "In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens," Obama said in a

statement."That is why I'm so pleased that Democrats and Republicans in the House of Representatives came together to provide health insurance to over ten million children whose families have been hurt most by this downturn. This
coverage is critical, it is fully paid for, and I hope that the Senate acts with the same sense of urgency so that it can be one of the first measures I sign into law when I am President." The Senate Finance Committee is expected to approve a similar bill on Thursday, with action by the full Senate to follow quickly. The bills would be financed by an increase in tobacco taxes, including a 61-cent increase in the tax on cigarettes, to $1 pack. The House bill includes a major new provision that would allow states to restore health insurance benefits to legal immigrants under 21. Under current law, legal immigrants are generally barred from Medicaid and the State Children's Health Insurance Program for five years after they enter the United States. The House bill would allow states to do away with that waiting period for children and pregnant women.

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Plan Popular-Lobbies
The Caucus, The Politics and Government Blog of the Times, 7-21 (Lobbying Increases as Health Care Debate Intensifies, 7-21-09, http://thecaucus.blogs.nytimes.com/2009/07/21/lobbyingincreases-as-health-care-debate-intensifies/?scp=8&sq=health%20care&st=cse)

Drug makers, advocacy groups, biotechnology firms and insurance companies have ratcheted up efforts to offer their two centsand in most cases much, much morein influencing the health care legislation now working its way through Congress. Many familiar health groups in recent months have increased lobbying spending by more than $1 million, according to second-quarter lobbying records filed on Monday with the Senate Office of Public Records. AARP, the
lobby for older Americans which has praised the legislation passed by two House committees, spent $5.3 million on lobbying between April 1 and June 30, $1.2 million more than the group spent in the first quarter. The Blue Cross and Blue Shield Association, a trade group, spent more than $2.8 million last quarter, up from $1.8 million in the first quarter. Drug maker GlaxoSmithKline invested $2.3 million in lobbying activities, an increase from the $1.8 million reported for the earlier quarter. Rival drug maker Novartis paid out $1.8 million, up from $1.3 million. And insurance company Allstate, which spent less than $900,000 through March, increased its lobbying spending to more than $1.5 million in the last three months. Biotechnology firms, like Amgen, Inc. which reported spending $3.4 million last quarter, up from $2.8 million are also bringing in the big bucks. But as the debate in Washington intensifies, lobbying tabs at some other major organizations have shrunk. Pharmaceutical Research and Manufacturers of America, or PhRMA, the drug industrys trade group, spent $6.2 million, down from $6.9 million in the first quarter. Pfizer, one of the worlds largest pharmaceutical companies, also cut spending from $6.1 million to $5.6 million. Still, the two groups spent the most of all health care organizations last quarter. The American Medical Association, which endorsed the House overhaul bill last week, spent $4 million, a full million less than they spent in the fourth quarter of 2008. Other organizations managed to ramp up their public

profile with well-timed advertisements instead of spending more to influence lawmakers. Americas Health Insurance Plans, which spend approximately the same this year compared to last year, voiced frustration with President Obamas public option plan in a new ad calling for bipartisan legislation that would mandate universal health care. The American Cancer Society Cancer Action Network also reduced spending this quarter from $1 million to $940,000,
but invested in a large advertising campaign in Washingtons Metro system. The sweeping nature of the legislation under consideration has also drawn in groups that ordinarily have little stake in health care issues. The American Beverage Association, which has been fighting proposals to tax sodas to pay for health care, spent $1.2 million on lobbying in the second quarter, almost nine times its $140,000 in the first quarter. Wal-Mart Stores Inc., a discount chain that recently came out in support of mandatory employer provided health insurance in a brake with many other business, increased its spending on lobbying to $2.58 million in the second quarter from $1.52 million in the first quarter.

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2AC: Military DA
1. Non-Unique: Universal Health Care is coming at the end of this summer U.S. House of Representatives released Tuesday a 1,000-page bill that would make health care a universal right. U.S. President Barack Obama is set to begin the push and hopes to make the bill law by the end of summer. The plan will cost at least $1.5 trillion over the next ten years. The bill would make health care a right for all in the United States and would, according to the Associated Press, leave a hefty part of the bill on
The employers and the wealthy. The U.S. House of Representatives released Tuesday their version of the bill and Senate Majority Leader Harry Reid wants to begin debating the topic next week. Democrats are pressing the urgency of

passing a health care overhaul. 2. The military accepts persons with citizenship or permanent residency- illegal immigrants dont have that. 3. Plan develops educated recruits for the military Schulz, Senior Fellow at the Center for American Progress, 09
(William F. Schultz, Adjunct Professor of International Relations at The New School, June 2009, The Power of Justice, Center for American Progress, http://www.americanprogress.org/issues/2009/06/pdf/humanrights.pdf [Abhik]) Moreover, as Nye, Thomas Friedman, Leslie Gelb, and many other respected foreign policy analysts have repeatedly pointed out, to stay competitive in a globalized world the United States must rectify shortcomings in its educational system, the exorbitant cost of its health care, and the failure to provide what Friedman has called lifetime employability, which he characterizes not as the guarantee of a lifetime job but the chance to make [oneself] more employable.36This means that addressing social and economic rights to close the achievement gap between well-off children and othersa gap that is above the average for the Organization for Economic Cooperation and Developments 29 industrialized nationsis not just a nice idea. It is a matter of national security, as is the need to make health care more affordable or job retraining more accessible in order for dollars and productivity not to be wasted.37 Among other things, failure to improve such conditions makes it harder to

find healthy, educationally qualified recruits for an all-volunteer army that often draws from the lower economic strata of the society. It also leaves the United States vulnerable to international economic pressures as
President Obama has discovered when he has tried to convince European nationswhich have far stronger safety nets than the United Statesto join in stimulus spending to end the recession.38 In all these ways and more international human

rights standards point the way to a safer, stronger America that is more respected and more economically resilientto say nothing of more just. As President-elect Obama put it in his Human Rights Day statement on December 10, 2008, standing up for human rights strengthen[s] our security and well-being, because the abuse of human rights can feed many of the global dangers that we confront.39 But if that is the case, then
why have Americans and their leaders been at best indifferent and at times downright hostile to the application of international standards to our domestic practices?

4. Soft Power solves international security, WMD proliferation, terrorism, and resource wars- thats Stanley in 07 5. Plan prevents Mexican collapse which is key to maintaining heg- we turn that DA- thats McDonald and Haddick from the 1AC.

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6. No Brink- Losing a few immigrant recruits wont collapse recruitment and hegemony- they cant prove that immigrants are key to hegemony. 7. Inevitable A. Recession causes people to join military
Bumiller, national affairs correspondent for the New York Times, 7-20 (Elisabeth Bumiller, national affairs correspondent for the New York Times, 7-20-09, http://www.nytimes.com/2009/07/21/world/21military.html)

Pentagon officials said they expected to increase the size of the Army through more recruitment and increased retention of the existing force. Recruitment is already up this year because the recession has lured people to the steady paychecks of the military. Officials said they also expected the Army to encourage re-enlistment so more soldiers would
serve beyond the standard two years.

B. Stimulus means job growth inevitable. CQ News, July 5

(Biden Foresees More Stimulus-Related Job Creation, 7-5-09 http://www.cqpolitics.com/wmspage.cfm?docID=news000003158539) Vice President Joseph R. Biden Jr. acknowledged Sunday that the administration made a mistake in assessing the depth and gravity of the nations economic crisis but predicted stepped-up job creation as more money in the economic stimulus package rolls out. ...the truth is, there was a misreading of just how bad an economy we inherited ... but we are now only about 120 days into the recovery package, he said on ABCs This Week. No one anticipated, no one expected that that

recovery package would in fact be in a position at this point of having distributed the bulk of the money. He conceded that the current unemployment rate, 9.5 percent, is much too high, and what we have to do, is we have to, as this [stimulus] rolls out, put more pace on the ball. The second hundred days, youre going to see a lot more jobs created. And the reason you are is now all of these contracts for the over several thousand highway projects that have approved. <<Read RMA Add-on to access another internal to solve heg>>>

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Bad Economy is responsible for high recruitment The State, 7-15
(The State, South Carolina Newspaper, Recession builds large pool of Army recruits, 7-15-09, http://www.thestate.com/local/story/864319.html)

A sagging economy, declining casualty rate in Iraq and a resurgence in the U.S. militarys popularity appear to have contributed to a strong recruiting year, Army leaders said. And the steady training schedule at Fort Jackson is likely to continue
into next year as recruits find themselves on a waiting list to report for duty. Shipping dates are anywhere from six weeks to two to three months out, said Sgt. 1st Class Jay Jenkins, who works at the Armys downtown Columbia recruiting station on Assembly Street. If recruiting continues at its current pace, the Army could have about 40,000 recruits in the future soldier program by Oct. 1, Army officials said. That compares with 11,000 who were in the program a year earlier. Recruits in the program include people who want to wait until they graduate from high school or college, and those who cant enter until there is a seat available in a training school, said Leslie Ann Sully, spokeswoman for the Columbia Recruiting Battalion. Those who sign up can wait up to a year before reporting for duty, Sully said. Having such a large pool of people waiting to report to Fort Jackson helps smooth out training schedules, said Col. Kevin Shwedo, deputy commander. The summer surge has been problematic for years, Shwedo said, explaining additional staffing was needed for a short period. But with thousands waiting to ship, Fort Jackson commanders can establish a straight line in the training schedule, Shwedo said. You dont have to build any slack into your personnel training schedule. This years training scene at Fort Jackson contrasts with 2005 when chow halls were closed and civilian staff were laid off because of the low recruit numbers. Recruiting has been so heavy that many local offices have already reached their goals for the 2009 fiscal year, which ends Sept. 30, and are working toward 2010. The Army has yet to establish a recruiting goal for 2010. Through June, the Army had enlisted 48,565 for active duty 4 percent above its goal. The Columbia battalion already has rolled past its 2009 goal, signing up 2,166 men and women. Its goal for the year was 1,853. The battalion recruits western North Carolina, the Charlotte and Augusta areas, and South Carolina except for the Charleston area. Army officials say the economy, with unemployment nationally

at 9.7 percent and 12.1 percent in South Carolina, has had an impact on recruiting. With every 10 percent increase in the number of people unemployed, theres a 6 percent boost in recruiting, said Douglas Smith, spokesman for the Army Recruiting Command at Fort Knox, Ky

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Massive Social Service spending and legislation in the status quo Federal Times, 7-24 Federal Times News, 7-24-09, House passes spending bill for education, health, labor , http://federaltimes.com/index.php?S=4204841) The House passed

its most expensive fiscal 2010 spending bill Friday, approving $730.5 billion in spending for the Education, Health and Human Services, and Labor departments. The bill contains $160.7 billion in discretionary spending for the agencies, $5.6 billion more than 2009 and close to what President Barack Obama had requested. It includes $567 billion for mandatory programs, $48.3 billion more than 2009. This funds entitlement programs such as Medicare, Medicaid, Supplemental Security Income and Black Lung payments. The bill also would: Add $1 million for the Health Resources and
Services Administrations Emergency Medical Services for Children program, paid by taking $1 million in funding for the Labor Departments departmental management. Add $1 million for the Centers for Disease Control and Preventions National Center for Health Statistics, paid for by taking $1 million from HHS general departmental management. Ban the use of funds appropriated in the bill to purchase light bulbs, unless the light bulbs have the Energy Star or Federal Energy Management Program label. Ban the purchase of first-class travel by employees of agencies funded in the act, if the tickets are purchased with money appropriated in the bill. Many federal agencies enjoyed significant funding increases in the bill, including: $31.3 billion for the National Institutes of Health, $942 million more than 2009. $11.4 billion for the Social Security Administrations administrative expenses, $993 million more than 2009. The increase will help the administration tackle a growing number of backlogged claims, which has increased as the economy has increased demand for SSA benefits. $ 6.7 billion for the Centers for Disease Control and Preventions discretionary public health programs, $67 million more than 2009.

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Perm Do Both Perm Do the plan and Reject capitalism in every other instance, this puts the neg in a double-bind. Either: (a.) the permutation solves the links to the criticism or (b.) the alternative isnt strong enough to overcome the Status Quo or any residual links to the Kritik Their rejection alternative is illegitimate and a voting issue for the following reasons: (a.) Ground trade-off They can find anything wrong with the affirmative as reasons to reject it and generate uniqueness but we dont get to generate any offense which means they will always control the direction of offense. (b.) Education loss We dont get to discuss possible venues to solve the problems they are indicting. If their criticism is so important, then we should be able to debate and learn strategies that are compatible with it - instead they make debate a idealistic activity where we do nothing which their authors would indict. (c.) Its Utopian Fiat They can claim solvency and uniqueness by arbitrarily fiating the ballot as their solvency mechanism. The plan is key to destroying the capitalist system granting equal rights to immigrants will help bridge inequality inherent in the capitalist system Socialist Labor Party, 07
(The American Socialist Labor Part, The Immigration Issue, Who Benefits? resolution adopted by the Socialist Labor Partys 47th National Convention, July 16, 2007, http://www.slp.org/pdf/statements/immigration07.pdf [Abhik])

class struggle is a fact, that the working and ruling classes of the world have nothing in common, and that every attempt to prevent the working classes of the world from uniting in their own interests requires the unqualified condemnation of all those who profess to speak in the interests of labor, regardless of their assertions and pretenses to the contrary. For that reason, the SLP reaffirms its commitment to the principle that unrestricted emigration of workers from one country to another is a human right, and that every attempt to limit, control or manipulate the working classes of the world in the free exercise of that right is meant to serve the interests of the ruling classes of the world and also requires the unqualified condemnation of all those who profess to speak in the interests of labor. Accordingly, the SLP reiterates its demand for the abolition of all laws designed to restrict or manipulate the immigration of workers into the United States, rebukes recent attempts by the Bush administration and by
The Socialist Labor Party of America reasserts that the international Congress to overhaul rather than repeal those laws, and denounces every attempt to conceal the real motives behind these

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efforts under the guise of such false pretenses as national security, protecting the wages and living standards of American workers against unfair competition from immigrant labor, or defending immigrant workers against ruthless exploitation by unscrupulous employers. Recently, one such attempt at manipulating the nations restrictions on free immigration failed in the U.S. Senate. Republican Sen. Arlen Specter falsely asserted the purpose of that attempt when he said, It is indispensable to have a guest worker program to take care of the needs of the economy.Many others who supposedly support immigrants also have asserted that the U.S. economy would collapse if every undocumented worker were deported from our country because such industries as agriculture, hospitality, health care, manufacturing and construction rely on immigrants, and that they are working the jobs that native-born workers do not want. Regardless of the motivation behind such an argument, no capitalist who benefits from the exploitation of immigrant labor would disagree with it. Moreover, the argument is false no matter who puts it forward because there are millions of unemployed Americans who would willingly fill those jobs if they were not dirty, dangerous and so poorly paidconditions fully within the control of those industries to change. However, if the argument were true it would only attest that capitalism cannot survive without

the vicious exploitation of labor and the perpetuation of human misery. Such a system condemns itself out of hand and does not deserve to survive. Still others having different motives and concerns mistakenly scapegoat immigrants as the source of stagnant or falling wages, declining living standards and unemployment, and call for punitive measures against them. In truth, however, unemployment, and whatever pressure immigrant labor places on wages, is a direct result of the competitive capitalist system itself. It is a byproduct of the system of wage labor, which forces workers to compete for their livelihoods on the basis of the conditions laid down by the capitalist system. Accordingly, efforts to scapegoat immigrants only serve to divide workers against one another, place greater hardships on immigrants and their families, and draw attention away from the capitalist source of these problems . In addition, the SLP recognizes that millions of workers who have immigrated to the United States in hopes of improving their lives have been bitterly disappointed and subjected to the most ruthless exploitation by the American ruling class. Indeed, the recently proposed but defeated guest worker program was similar to and in
some respects indistinguishable from past efforts by Americas capitalist class to control and import cheap labor to maximize profits, e.g., the infamous Bracero Program that brought in millions of poor, unskilled Mexican workers on a temporary basis from 1942 to 1964. Moreover, the so-called unions that support the capitalist system of

exploitation deserve special condemnation because they have sought to benefit from such conditions by ingratiating themselves with immigrant workers and opportunistically pretending to represent their interests. From the preceding it is clear that capitalism with its private ownership of the economy and exploitation of wage labor is responsible for economic hardship and insecurity for all workers; that it compels workers for economic reasons to leave their home countries and seek employment elsewhere; that immigration laws, whether promoted by so-called liberals or conservatives, only serve to benefit the capitalist class.

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The alt fails - Only GRADUAL resistance like the plan effectively break down capitalism Wilson, Coordinator of the Independent Press Association, 00
(John K., coordinator of the Independent Press Associations Campus Journalism Project, How the Left can Win Arguments and Influence People, pg 121- 123)

Progressives need to be pragmatic in order to be powerful. However, pragmatism shouldn't be confused with Clintonian centrism and the abandonment of all substance. Pragmatists have principles, too. The difference between a pragmatic progressive and a foolish one is the willingness to pick the right fights and fight in the right way to accomplish these same goals. The current failure of progressivism in America is due to the structure of
American politics and media, not because of a wrong turn that the movement took somewhere along the way. What the left needs is not a "better" ideology but a tactical adaptation to the obstacles it faces in the contemporary political scene. A pragmatic progressivism does not sacrifice its ideals but simply communicates them better to the larger public. The words we use shape how people respond to our ideas. It's tempting to offer the standard advice that progressives should present their ideas in the most palatable form. But palatable to whom? The media managers and pedestrian pundits who are the intellectual gatekeepers won't accept these ideas. By the time progressives transform their ideas into the political baby food necessary for inclusion in current debates, it barely seems to be worth the effort. Leftists need to seize the dominant

political rhetoric, even though it may be conservative in its goals, and turn it in a progressive direction. Progressives need to use the anti-tax ideology to demand tax cuts for the poor. Progressives need to use the antigovernment and anti-welfare ideology to demand the end of corporate welfare. Progressives need to
translate every important issue into the language that is permissible in the mainstream. Something will inevitably be lost in the translation. But the political soul underlying these progressive ideas can be preserved and brought to the public's attention. The left does not need to abandon its progressive views in order to be popular. The left only needs to abandon some of its failed strategies and become as savvy as the conservatives are at manipulating the press and the politicians. The language of progressives needs to become more mainstream, but the ideas must remain radical. In an age of soulless politicians and spineless ideologies, the left has the virtue of integrity. Until progressives become less self-satisfied with the knowledge that they're right and more determined to convince everyone else of this fact, opportunities for political change will not be forthcoming. Progressives have also been hampered by a revolutionary instinct among some leftist groups.

According to some left wingers, incremental progress is worthless-that is, nothing short of a radical change in government will mean anything to them. Indeed, for the most radical left wingers, liberal reforms are a threat to the movement, since they reduce the desire for more extreme changes. What the revolutionaries fail to realize is that progressive achievements can build on one another. If anything approaching a political revolution actually happens in America, it will be due to a succession of popular, effective, progressive reforms.

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Individual Greed is the root cause of conflict NOT Cap The Kritik only perpetuates Human Rights Problems means case is a DA to the alt Aberdeen, Producer of Freedom Records, 03
(Richard Aberdeen, August 20th 2003, http://freedomtracks.com/uncommonsense/theway.html [Abhik])

A view shared by many modern activists is that capitalism, free enterprise, multi-national corporations and globalization are the primary cause of the current global Human Rights problem and that by striving to change or eliminate these, the root problem of what ills the modern world is being addressed. This is a rather unfortunate and historically myopic view, reminiscent of early class struggle Marxists who soon resorted to violence as a means to achieve rather questionable ends. And like these often brutal early Marxists, modern anarchists who resort to violence to solve the problem are walking upside down and backwards , adding to rather than correcting, both the immediate and long-term Human Rights problem. Violent revolution, including our own American revolution, becomes a breeding ground for poverty, disease, starvation and often mass oppression leading to future violence. Large, publicly traded corporations are created by individuals or groups of individuals, operated by individuals and made up of individual and/or group investors. These business enterprises are deliberately structured to be empowered by individual (or group) investor greed. For example, a
theorized need for offering salaries much higher than is necessary to secure competent leadership (often resulting in corrupt and entirely incompetent leadership), lowering wages more than is fair and equitable and scaling back of often hard fought for benefits, is sold to stockholders as being in the best interest of the bottom-line market value and thus, in the best economic interests of individual investors. Likewise, major political and corporate exploitation of third-world nations is rooted in the individual and joint greed of corporate investors and others who stand to profit from such exploitation. More than just investor greed, corporations are driven by the greed of all those involved, including individuals outside the enterprise itself who profit indirectly from it. If one examines the course of human events closely, it can correctly be surmised that the root cause of humanitys problems comes from individual human greed and similar negative individual motivation. The Marx/Engles view of history being a class struggle does not address the root problem and is thus fundamentally flawed from a true historical perspective (see Gallo Brothers for more details). So-called classes of people, unions, corporations and political groups are made up of individuals who support the particular group or organizational position based on their own individual needs, greed and desires and thus, an apparent class struggle in reality, is an extension of individual motivation. Likewise, nations engage in wars of aggression, not because capitalism or classes of society are at root cause, but because individual members of a society are individually convinced that it is in their own economic survival best interest. War, poverty, starvation and lack of Human and Civil Rights have existed on our planet since long before the rise of modern capitalism, free enterprise and multi-national corporation avarice, thus the root problem obviously goes deeper than this. Junior Bush and the neo-conservative genocidal maniacs of modern-day America could not have recently effectively gone to war against Iraq without the individual support of individual troops and a certain percentage of individual citizens within the U.S. population, each lending support for their own personal motives, whatever they individually may have been. While it is true that corrupt leaders often provoke war, using all manner of religious, social and political means to justify, often as not, entirely ludicrous

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very rare indeed is a battle only engaged in by these same unscrupulous miscreants of power. And though a few iniquitous elitist powerbrokers may initiate nefarious policies of global genocidal oppression, it takes a very great many individuals operating from individual personal motivations of survival, desire and greed to develop these policies into a multi-national exploitive reality. No economic or political organization and no political or social cause exists unto itself but rather, individual members power a collective agenda. A workers strike has no hope of succeeding if individual workers do not perceive a personal benefit.
ends, And similarly, a corporation will not exploit workers if doing so is not believed to be in the economic best interest of those who run the corporation and who in turn, must answer (at least theoretically) to individuals who collectively through purchase or other allotment of shares, own the corporation. Companies have often been known to appear benevolent, offering both higher wages and improved benefits, if doing so is perceived to be in the overall economic best interest of the immediate company and/or larger corporate entity.

Capitalism is inevitable - The Negatives discourse cedes the political sphere to the right. Wilson, Coordinator of the Independent Press Association, 00
(John K., coordinator of the Independent Press Associations Campus Journalism Project, How the Left can Win Arguments and Influence People, pg 15- 16)

Capitalism is far too ingrained in American life to eliminate. If you go into the most impoverished areas of America, you will find that the people who live there are not seeking government control over factories or even more social welfare programs; they're hoping, usually in vain, for a fair chance to share in the capitalist wealth. The poor do not pray for socialism-they strive to be a part of the capitalist system. They want jobs, they want to start businesses, and they want to make money and be successful. What's wrong with
America is not capitalism as a system but capitalism as a religion. We worship the accumulation of wealth and treat the horrible inequality between rich and poor as if it were an act of God. Worst of all, we allow the government to exacerbate the financial divide by favoring the wealthy: go anywhere in America, and compare a rich suburb with a poor town-the city services, schools, parks, and practically everything else will be better financed in the place populated by rich people. The aim is not to overthrow capitalism but to overhaul it. Give it a social-justice tune-up, make it more efficient, get the economic engine to hit on all cylinders for everybody, and stop putting out so many

environmentally hazardous substances. To some people, this goal means selling out leftist ideals for the sake of capitalism. But the right thrives on having an ineffective opposition. The Revolutionary Communist
Party helps stabilize the "free market" capitalist system by making it seem as if the only alternative to free-market capitalism is a return to Stalinism. Prospective activists for change are instead channeled into pointless

discussions about the revolutionary potential of the proletariat. Instead of working to persuade people to accept progressive ideas, the far left talks to itself (which may be a blessing, given the way it communicates) and tries to sell copies of the Socialist Worker to an uninterested public.

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Turn - Cap solves war through free trade, democracy and wealth distribution Griswold, Director of the Center for Trade Policy Studies, 05
(Griswold-director of Center for trade policy studies at Cato, "Peace on earth? Try free trade among men", 2005, www.freetrade.org/node/282) As one little-noticed headline on an Associated Press story recently reported, "War declining worldwide, studies say."

According to the Stockholm International Peace Research Institute, the number of armed conflicts around the world has been in decline for the past half century. In just the past 15 years, ongoing conflicts have
dropped from 33 to 18, with all of them now civil conflicts within countries. As 2005 draws to an end, no two nations in the world are at war with each other. The death toll from war has also been falling. According to the AP story, "The number killed in battle has fallen to its lowest point in the post-World War II period, dipping below 20,000 a year by one measure. Peacemaking missions, meanwhile, are growing in number." Those estimates are down sharply from annual tolls ranging from 40,000 to 100,000 in the 1990s, and from a peak of 700,000 in 1951 during the Korean War. Many causes lie behind the good news -- the end of the Cold War and the spread of democracy, among them -- but expanding trade and globalization appear to be playing a major role. Far from stoking a "World on Fire," as one misguided American author has argued, growing commercial ties between nations have had a dampening effect on

armed conflict and war, for three main reasons. First, trade and globalization have reinforced the trend toward democracy, and democracies don't pick fights with each other. Freedom to trade nurtures democracy by
expanding the middle class in globalizing countries and equipping people with tools of communication such as cell phones, satellite TV, and the Internet. With trade comes more travel, more contact with people in other countries, and more exposure to new ideas. Thanks in part to globalization, almost two thirds of the world's countries today are democracies -- a record high. Second, as national economies become more integrated with each other, those nations have more to lose should war break out. War in a globalized world not only means human casualties and bigger government, but also ruptured trade and investment ties that impose lasting damage on the

economy. In short, globalization has dramatically raised the economic cost of war. Third, globalization allows nations to acquire wealth through production and trade rather than conquest of territory and resources. Increasingly, wealth is measured in terms of intellectual property, financial assets, and human capital.

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Perm Do Both No solvency The only way to solve Drug Trafficking is through preventative treatment Bonello, International Correspondent for the Los Angeles Times, 08
(Deborah Bonello, Los Angeles Times, October 9th 2008, U.N.'s head of anti-drug trafficking warns against legalization, http://latimesblogs.latimes.com/laplaza/2008/10/in-the-americas.html [Abhik])

"In the Americas, the biggest threat to public safety comes from drug trafficking and the violence perpetuated by organized crime," said Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime (UNODC) speaking in Mexico City yesterday. "Urban violence in the U.S., biker gangs in
Canada, violence and kidnapping in Mexico, pandillas and maras in Central America, thugs in the Caribbean, gangs in Brazilian shanty towns, insurgency in Colombia -- in every case there is a connection to drugs," Costa said. He urged

governments not to be tempted to legalize drugs such as cocaine and methamphetamine, saying: "At this point, we know what some people -- the pro-drug lobby, for example -- would say: 'Legalize drugs and crime will disappear.' In other words, while facing an undeniably tough problem, we are invited to accept it, hide our head in the sand and make it legal. "I do not agree, and let me explain why by using an analogy. Human trafficking is another tough crime problem, worldwide -- perhaps second in size, after drug trafficking. Should we legalize modern slavery, given the intrinsic difficulty in dealing with it? Of course not." Instead, he called for more to be done across the hemisphere to tackle the problem from the demand and supply end, working more towards reducing the cultivation, processing and trafficking of drugs. He added: "Until the number of cocaine users falls worldwide, the problems caused by narco-trafficking will be displaced (as we are now seeing in West Africa) rather than solved. Therefore, more attention and resources must be devoted to drug prevention and treatment. Demand and supply reduction measures will inevitably contain the trafficking problem and the crimes associated to it." Mexico is currently in the grip of
surging levels of drug-related violence. President Felipe Calderon has sent 40,000 soldiers and 5,000 federal police officers to secure large swaths of the country against its powerful drug cartels. In the nearly two years since Calderon launched a crackdown against drug gangs, more than 4,000 people have died

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No Solvency Government Agencies wont give out potent drugs to solve drug violence USDEA, No Date
(U.S. Drug Enforcement Agency, Fact 7: Crime, http://www.usdoj.gov/dea/demand/speakout/07so.htm [Abhik]) Violence, and Drug Use Go Hand-In-Hand,

In addition, any government agency assigned to distribute drugs under a legalization scenario would, for safety purposes, most likely not distribute the most potent drug. The drugs may also be more expensive because
of bureaucratic costs of operating such a distribution system. Therefore, until 100 percent pure drugs are given away to anyone, at any age, a black market will remain.

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No Solvency Legalization creates a new black market for drugs and will not solve for drug cartel violence USDEA, No Date
(U.S. Drug Enforcement Agency, Fact 7: Crime, http://www.usdoj.gov/dea/demand/speakout/07so.htm [Abhik]) Violence, and Drug Use Go Hand-In-Hand,

Proponents of legalization have many theories regarding the connection between drugs and violence. Some dispute the connection between drugs and violence, claiming that drug use is a victimless crime and users are putting only themselves in harms way and therefore have the right to use drugs. Other proponents of legalization contend that if drugs were legalized, crime and violence would decrease, believing that it is the illegal nature of drug production, trafficking, and use that fuels crime and violence, rather than the violent and irrational behavior that drugs themselves prompt. Yet, under a

legalization scenario, a black market for drugs would still exist. And it would be a vast black market. If drugs were legal for those over 18 or 21, there would be a market for everyone under that age. People under the age of 21 consume the majority of illegal drugs, and so an illegal market and organized crime to supply it would remainalong with the organized crime that profits from it. After Prohibition ended, did the organized crime in our country go down? No. It continues today in a variety of other criminal enterprises. Legalization would not put the cartels out of business; cartels would simply look to other illegal endeavors. If only marijuana were legalized, drug traffickers would continue to traffic in heroin and cocaine. In either case, traffic-related violence would not be ended by legalization. If only marijuana, cocaine, and heroin were legalized, there would still be a market for PCP and methamphetamine. Where do legalizers want to draw the line? Or do they support legalizing all drugs, no matter how addictive and dangerous? Turn Your authors are WRONG Legalization increases crime and addiction USDEA, No Date
(U.S. Drug Enforcement Agency, Fact 7: Crime, http://www.usdoj.gov/dea/demand/speakout/07so.htm [Abhik]) Violence, and Drug Use Go Hand-In-Hand,

The greatest weakness in the logic of legalizers is that the violence associated with drugs is simply a product of drug trafficking. That is, if drugs were legal, then most drug crime would end. But most violent crime is committed not because people want to buy drugs, but because people are on drugs. Drug
use changes behavior and exacerbates criminal activity, and there is ample scientific evidence that demonstrates the links between drugs, violence, and crime. Drugs often cause people to do things they wouldnt do if they were rational and free of the influence of drugsWhen legalizers suggest that easy access to drugs wont contribute to greater levels of addiction, they arent being candid. The question isnt whether legalization will increase addiction levelsit will its

whether we care or not. The compassionate response is to do everything possible to prevent the destruction of addiction, not make it easier.

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Increased Crime destroys consumer confidence De Mello and Zilberman, Members of the Department of Economics at NYU 07
(Joo M P De Mello, Departamento de Economia, PUC-Rio, and Eduardo Zilberman, Department of Economics, New York University, May 2007, Does Crime Affect Economic Decisions? An Empirical Investigation of Savings in a High-Crime Environment,)

Crime taxes consumption through three different mechanisms. First, the utility from consuming is lower in a dangerous environment for instance; a night out on the town is less enjoyable if one is worried about getting mugged. Second, a higher crime rate increases the probability of a bad state occurring (being victimized), thus distorting an individuals preferences. For example, in high-crime environments, the consumption of .ashy goods, such as sports cars or designer clothing, increases the probability of robbery and theft. Third, crime reduces consumption opportunities as businesses may respond to crime by reducing their hours of operation or relocating to a safer neighborhood. Broadly speaking, these three mechanisms increase the price of consumption. Anecdotal evidence supports the assertion that crime taxes consumption. A Consumer Expectation Survey conducted in the city of Rio de Janeiro showed that violence was the main reason for consumers pessimism, not inflation or unemployment. After news of a string of robberies or gang sights, customer presence in shopping centers was reported to drop 25 percent (see Jornal O Globo, 08/10/2004). Moreover, anecdotal evidence from newspapers suggest that individuals have substituted luxury automobiles for less conspicuous models out of fear of car theft (see Jornal O Globo, 04/16/2006). Two points should be noted. First, people may substitute risky (conspicuous) consumption for safer consumption: a night out at the cinema, for instance, may be replaced by renting a movie. Second, savings are postponed consumption. Therefore, increased savings in the presence of crime is only rational if individuals expect crime to fall in the future. Indeed, crime rates reached their peak in 2000 and have since dropped substantially. Consumer confidence is key to the economy Lee, Professor of Econ at Texas A&M University, 03
(Jim Lee, Professor of Economics at Texas A&M University-Corpus Christi, Oct. 02 What is the role of consumer confidence in the business cycle, and how does it affect the economy?)

Consumers play a major role in the economy. This is because consumer spending accounts for twothirds of U.S. output. Since households economic outlook affects their spending behavior, their expectations influence the direction of economic activity in the business cycle. Consumer confidence, or
optimism about the overall economy, is commonly referred to as animal spirits after a famous economist, John Maynard Keynes. Keynes asserted that the Great Depression of the 1930s was largely attributable to a collapse of public confidence, which led to dramatic declines in consumer and business spending. Today, consumer confidence receives a great deal of media attention. Rising consumer confidence is widely interpreted as a

precursor to higher future household spending. It is therefore a leading indicator of the overall economy. If consumers are more optimistic about the economy, they will tend to spend more, especially on durable goods and other large purchases. A higher overall demand for goods and services will subsequently lead to higher output and employment.

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Economic Decline Leads to Global War - Empirically Proven Mead, Senior Fellow on the Council of Foreign Relations, 09
(Walter Russell, is the Henry A. Kissinger Senior Fellow in U.S. Foreign Policy at the Council on Foreign Relation, Only Makes You Stronger http://www.tnr.com/politics/story.html?id=571cbbb9-2887-4d81-8542-92e83915f5f8) None of which means that we can just sit back and enjoy the recession. History may suggest that financial crises actually help capitalist great powers maintain their leads--but it has other, less reassuring messages as well. If financial crises

have been a normal part of life during the 300-year rise of the liberal capitalist system under the Anglophone powers, so has war. The wars of the League of Augsburg and the Spanish Succession; the Seven Years War; the American Revolution; the Napoleonic Wars; the two World Wars; the cold war: The list of wars is almost as long as the list of financial crises. Bad economic times can breed wars. Europe was a pretty peaceful place in 1928, but the Depression poisoned German public opinion and helped bring Adolf Hitler to power. If the current crisis turns into a depression, what rough beasts might start slouching toward Moscow, Karachi, Beijing, or New Delhi to be born? Legalization will not stimulate the economy Montopoli, Political Reporter for CBS News, 3-26
(Brian Montopoli, Covered press coverage of the 2004 campaign for Columbia Journalism Review, he has contributed to The New York Times, The Los Angeles Times, Slate, Legal Affairs, and The Washington Monthly, and has appeared on National Public Radio, Legalizing Pot Wont Grow Economy, 3-26-09 http://www.cbsnews.com/blogs/2009/03/26/politics/politicalhotsheet/entry4894639.shtml)

President Obama today held an online town hall meeting in which he answered questions submitted to the White House web site. As CBS News' Chief Political Correspondent Marc Ambinder points out, the top-rated questions in the budget and fiscal stability sections of the submissions page concerned the legalization of marijuana. (Heres one: With over 1 out of 30 Americans controlled by the penal system, why not
legalize, control, and tax marijuana to change the failed war on drugs into a money making, money saving boost to the economy? Do we really need that many victimless criminals?")Hotsheet did not expect President Obama to address the pot questions during the town hall, particularly after the event opened with a pair of relatively straightforward questions. But we were wrong: the president interrupted the event midway through to address the issue. we took votes

about which questions were going to be asked, and I think 3 million people voted or 3.5 million people voted, he said. I have to say that there was one question that was voted on that ranked fairly high, and that was whether legalizing marijuana would improve the economy and job creation. The president then
joked that I don't know what this says about the online audience, prompting laughter from the roughly 100 people gathered in the White House East Room for the event. but I just want -- I don't want people to think that -- this was a fairly popular question, he continued. We want to make sure that it was answered. (DEA) And then he answered it

in a way that must come as a disappointment to legalization advocates though they could at least take solace in the fact that he did not flatly state that he opposes legalization. The answer is, no, I don't think that is a good strategy to grow our economy, the president said. His answer prompted applause from the audience. (White House press secretary Robert Gibbs later clarified Mr. Obama's position: "The president opposes the legalization of marijuanahe does not think thats the right plan for America. Pressed by CBS News
White House correspondent Mark Knoller, Gibbs declined to discuss the president's position on medical marijuana.) Here's the video of the president: The online town hall was something of an odd affair: It was designed to show that the president is bypassing the media in order to directly address the concerns of the American people, and yet the White House itself selected the questions which meant that, potentially, the president could simply field a series of softballs and avoid questions he didnt like. So the presidents decision to address the pot issue is commendable after all, ignoring it would have gone against the very spirit of the event.

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Their impact turns dont apply because our advantage is predicated off the fact that the COLLAPSE of U.S. Hegemony is bad, which means if we win collapse of heg and subsequent U.S. withdrawal is bad we win control all offense on the heg debate Extend our Powell 08 card from the 1AC it indicates that restoring U.S. Human Rights Credibility is key to sustaining U.S. Leadership First, human rights principles are at the core of Americas founding values, and Americans (as well as others within our borders or in U.S. custody), no less than others around the world, are entitled to the full benefit of these basic guarantees. That can hardly be open to debate. The second reason is perhaps less obvious, but equally compelling. When the United States fails to practice at home what it preaches to others, it loses credibility and undermines its ability to play an effective leadership role in the world. Leading through the power of our example rather than through the example of our power3 is particularly critical now, at a juncture when the United States needs to cultivate international cooperation to address pressing issues such as the current economic downturn that have global dimensions. Perhaps not surprisingly, then, an overwhelming majority of Americans strongly embrace the notion of human rights: Immigration reform is key to sustaining U.S. capabilities Slaughter, Professor of Politics and International Affairs at Princeton, 09
(Anne-Marie Slaughter,The Bert G. Kerstetter '66 University Professor of Politics and International Affairs at Princeton University. Dean of the Woodrow Wilson School of Public and International Affairs, Princeton, Foreign Affairs, January- February 2009, America's Edge Subtitle: Power in the Networked Century, p. 94)

At the moment, the United States' edge in this new world is more potential than actual. The country will face a vast amount of work in digging itself out of the many holes it has gotten itself into, both at home and abroad. In the process, the United States must adopt five policies and postures that will seize on its edge and sharpen it. First, the United States must adopt comprehensive immigration reform that will make it easier for immigrants and guest workers to move across borders, regularize the status of the millions of illegal immigrants currently in the United States, and increase the number of visas for the world's most talented individuals. Part of changing U.S. attitudes toward immigration must include a recognition that because of their ties to their home countries, immigrants are potential engines of economic growth. New economic policies could
offer subsidies or tax incentives to immigrants who create businesses based on connections they have cultivated to markets and talent in their home countries. Instead of a one-way, outgoing flow of remittances, the United States needs a two-way flow of goods, services, and people. Second, as part of overhauling its educational system, the United States must come to see overseas study as an essential asset for all Americans. Indeed, organizations such as the BrownBell Foundation promote opportunities to study abroad for students at historically black colleges and universities, where such programs have traditionally been lacking. Just as important, the United States must see the children of immigrants who grow up learning Arabic, Hindi, Mandarin, Spanish, and other foreign languages as huge assets. Government programs and private initiatives should encourage them to study abroad in the countries of their parents or grandparents and, assuming they keep their U.S. passports, to gain dual citizenship. A networked world requires a genuinely networked society, which means fostering economic and social equality.

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U.S. Hegemony is sustainable The U.S. is dominant in every single sector Kreft, Senior Policy Advisor at CDU, 09
(Heinrich Kreft, senior foreign policy advisor to the CDU/CSU parliamentary group in the german bundestag, The World Today, February 2009, p. 11)

Obama and his Republican opponent John McCain expressed the view that the United States was and ought to remain the guarantor of international stability and the indispensable stabilising power. Against the backdrop of the present financial and economic crisis and rekindled discussion about the decline of US power, it is easy to overlook the fact that America is structurally superior to all other countries and will remain so for the foreseeable future. THE GEOGRAPHICAL DIMENSIONS OF THE UNITED States, its material resources and human capital, its military strength and economic competitiveness as well as its liberal political and economic traditions, are the ingredients of superiority. It has the capacity to heal its own wounds like no other country. STRENGTHS The US not only possesses large deposits of natural resources and vast areas of productive farmland, but also enjoys favourable medium- and long-term demographic trends. Thanks to immigration and a high birth rate, it has a young population compared to Europe, Japan, Russia as well as China. This makes the burden of providing for an ageing population far less onerous. In spite of the present crisis, the economy, which accounts for more than a quarter of the world's gross domestic product (GDP ), is essentially vibrant. Over the past twenty five years, its growth has been significantly higher than Europe's and Japan's; the economy is adaptable and more innovative than any other. It is the most competitive globally, with particular strengths in crucial strategic areas such as nanotechnology and bioengineering. The US has the best universities and research institutes and trains more engineers in relation to its population than any other major
During the presidential election campaign, both Barack economy. It invests 2.6 percent of its GDP in higher education, compared with 1.2 percent in Europe and 1.1 percent in Japan. President Barack Obama's plan for more educational investment aims to maintain this advantage

also against China, which is increasing its higher education investments. In the military domain too, no other country comes close to matching the capability of the US to project its power globally. America accounts for almost half of global military spending, six times more than China, its only potential rival.
Current defence spending, however, at 4.2 percent of GDP, is still far below the double-digit Cold War peak. Even if the cost of intervention in Iraq and Afghanistan runs at an annual figure of $125 billion, this is less than one per cent of GDP and hence considerably lower than the cost of the Vietnam war. In contrast to the 'hard power' of military strength, Iraq and the Guantnamo Bay and Abu Ghraib problems have severely dented the image and thereby diminished its 'soft power'. Nevertheless, the structural components of soft power remain intact, from US mass culture - the

dominance of American global communications such as the internet and television - to the unfailing appeal of its universities.

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Turn Its IMPOSSIBLE to predict when America will collapse and even if Hegemonic decline is inevitable withdrawing from the international system prematurely will create a global power vacuum and Great Power Wars Schweller, Professor of Political Science at Ohio State University, 01
(Randall Schweller, He is currently a member of the editorial board of International Security, In 1993, he received a John M. Olin Post-Doctoral Fellowship in National Security at the Center for International Affairs, Harvard University, The Problem of International Order Revisited, International Security, http://muse.jhu.edu/journals/international_security/v026/26.1schweller.html)

although hegemonic decline may be inevitable, it is not self-evident that a policy of strategic restraint better serves the hegemon's long- run interests than simply taking advantage of its power position to grab immediate gains. Indeed there is no a priori reason to conclude that instant post-war benefits (e.g., increases in the size of the new hegemon's territorial boundaries, spheres of influence, colonial possessions, etc.) will not continue to accrue significant future gains and thereby better serve to arrest the pace of hegemonic decline than Ikenberry's alternative of a constitutional peace settlement. [End Page 173] Because one can
First, make an equally impressive logical case to support either position, theoretical arguments alone will not tell us whether the choice to transform is more likely to benefit the hegemon over the long run than is he decision to dominate. It is ultimately an empirical question. In practice, there has been a strong relationship between the growth in power of a state and its desire to extend its territorial control, political influence, and domination of the international economy. 25 Great powers have tended to expand when they can. They have done so not necessarily to satisfy an innate lust for power, prestige, and glory--though history is replete with such cases--but rather because anarchy compels states to enhance their

security and influence over others and their environment whenever it is possible and pragmatic for them to do so. 26 Hegemonic postwar junctures are precisely when great powers, especially the leading state, can be expected to expand, not bind, their power. Because nature and politics abhor a vacuum, the victors will move quickly to fill the political vacuums left behind by the defeated great powers. This is predictable behavior because, when presented with such an extraordinary opportunity to expand the state's territory and influence, political leaders "can be said to act under external compulsion rather than in accordance with their preferences": 27 That is, their actions are driven by irresistible temptation. Second, even if decisionmakers believe that hegemonic decline is inevitable, there are plenty of reasons why they would not and should not act on that belief. First, leaders have few if any domestic incentives to abandon policies of autonomy and unilateralism in favor of multilateralism and self-restraint. The incentive structure
of elites, even foreign policy ones, is primarily a function of domestic, not international, politics. No matter how much internationalists may champion multilateral solutions, elected officials must answer to a domestic audience, and unelected bureaucrats must serve and promote the autonomy and interests of the bureaucratic organization to which they belong. Second, Ikenberry's claim rests on an unrealistic assumption about the time horizons of democratic leaders. Even if we concede the point that the creation of a constitutional order is a wise long-term investment for the new hegemonic [End Page 174] state, history records few decisionmakers who acted in such a farsighted manner. This is particularly true for leaders of democratic states, because the primary goal for most elected officials is to ensure reelection. Why, then, should we expect democratically elected policymakers of a newly hegemonic state to forgo immediate gains for long-run payoffs that may or may not be reaped decades later--long after

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the deliberate choice to restrain the exercise of power now because of the possibility (but not certainty) of exerting relatively less power later is like committing suicide for fear of death. The key question for postwar leaders is not whether but when decline will come and how much deterioration can be expected. Had American policymakers, for example, been persuaded by the chorus of scholars in the 1970s to late 1980s proclaiming that U.S. power was in terminal decline, the Cold War might have continued for decades longer; and it surely would not have ended in total victory for the West. Thankfully, instead of constraining American power and preparing for inevitable decline, the Reagan administration began ramping up U.S. power capabilities in the 1980s, arresting America's relative decline through bold policy choices. 28 Consequently, as Ikenberry himself acknowledges, "American power in the 1990s is without historical precedent" (p. 270). It is worth pointing out that even in the late 1980s, few if any foreign policy experts forecasted America's current supremacy in a unipolar world. This predictive failure, however, is not proof of the impoverishment of international relations theories, as many have claimed. 29 The (painful for some) truth is that the future power position of the United States or any other country is simply beyond prediction. This is because the power trajectories of nations, especially powerful ones, are not structurally determined; they are the result of wise or imprudent policy choices. Hence it is impossible to tell whether the United States has currently reached its power zenith, or is only halfway there, or is anywhere in between. 30 What can be said is that if current U.S. policymakers [End Page 175] act on the belief that Pax Americana is an artificial moment, they run the risk of achieving a foolish, self-fulfilling prophecy. More to the matters at hand, after fifty-six years of American leadership of the free world and still counting, it would have been a terrible mistake for U.S. policymakers to have acted on this assumption of inevitable decline in 1945, in accordance with Ikenberry's prescription
they have left office? Finally,

Turn - U.S. isolationism causes world war Mandelbaum, Professor of American Foreign Policy at JHU, 06
(Michael Mandlebaum, Professor of American Foreign Policy at Johns Hopkins University THE CASE FOR GOLIAATH: HOW AMERICA ACTS AS THE WORLDS GOVERNMENT IN THE TWENTY-FIRST CENTURY, 2006, pp. 186-7)

If public pressure within the United States were to compel the American government to withdraw most or all of the military forces stationed beyond North America and to do far less than it had become accustomed to doing to
discourage the spread of nuclear weapons, to cope with the consequences of fiscal crises outside its borders, and to help keep global markets open to trade, what impact would this have on the rest of the world? The last occasion on which the United States placed itself on the periphery rather than at the center of international affairs, the period between the two world wars, was not a happy one. Indeed, the antecedents of the American twenty- first-century role as the world's government lie in the fear, after World War II, that in the absence of

an expansive American international presence the world would experience repetitions of the two global disasters of the 1930s and the I940s-the Great Depression and World War II.

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1. Perm: Do the plan and embrace the alternative We can simultaneously be concerned about the institutions and assist human suffering this allows for the best solvency because we address problems at the theoretical level and through implementation Janet Finn and Maxine Jacobson, associate prof. and assistant prof. of social work at U of Montana, '02, (Just Practice: Steps Toward A New Social Paradigm, pg. 64-5) Practice theorists are concerned with the interplay of culture, power, and history in the making of social subjects and in the processes of social reproduction and change (Bourdieu, 1977; Dirks, Eley, & Ortner, 1994). For example, French sociologist Pierre Bourdieu asks how it is that we come to naturalize the arbitrary and internalize the external. He interrogates the patterns, practices, and routines of everyday life through which we reproduce the divisions, distinctions, and inequalities of society as a whole. He uses the concept of habitus to describe the socially acquired, internalized, and durable generative principles tbat dispose us to think, feel, and act in particular ways (Bourdieu, 1977). Bourdieu contends that habitus is both a product of our acculturation into certain social groups and a generative source for action in the world. We acquire modes of emotional expression, styles of social interaction, notions of "taste," beliefs about difference, and so forth in the context of social groups, and we internalize these dispositions such that they largely "go without saying." At the same time they are generative schemes, that is, they form part of our creative repertoire for interpreting and acting in the world. For example, we are shaped by our class, gender, and race-based experience, and we bring these dispositions and schemes to bear in our experiences as social workers {and clients) as both resources and constraints. Further, we are shaped by the language, practices, and meaning
systems of social work itself, which offer particular schemes for making sense of problems and strategies for helping with them. The practice perspective offers a "both and" approach that acknowledges the very real experience of

human suffering and struggle while simultaneously insisting that human experience is never outside of our socially constructed systems of meaning and power. Framework the judge should evaluate a competitive policy option - They can zero in on any one part of the 1AC and moot the rest of the debate 3. No Link the plan doesn't claim advantages that are for the benefit of solely institutions in power bioterror and human rights effects populations everywhere, both of which the US government has obligations to protect us against 4. Case Solves Impact to the Kritik - A social work paradigm needs to involve humanitarian work inclusive of people's differences Janet Finn and Maxine Jacobson, associate prof. and assistant prof. of social work at U of Montana, '02, (Just Practice: Steps Toward A New Social Paradigm, pg. 64-5) A new social work paradigm is needed to confront these challenges, tensions, and contradictions and to address human concerns that transcend national, geographic, and cultural borders and domains of practice. Social work scholars contend that we need an integrated approach grounded in the context of critical community practice (Johnson, 1998; Schorr, 1997), a greater emphasis on internationalism (Briar-Lawson, Lawson, Hennon, & Jones, 2001; Hokenstad & Midgley, 1997; Lyons, 1999; Ramanathan & Link, 1999; Sarri, 1997), the incorporation of a political dimension in practice and the preparation of social workers to serve as interpreters of environments for policy makers and the public (Reisch, 1997), and an engagement with critical postmodern theories that envision social work as an emancipatory project (Leonard, 1997; Pease & Fook, 1999). These issues call for approaches to thought and action that challenge our certainties, acknowledge our partial and positioned perspectives, and enable
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engagement with radically different ways of interpreting and acting in the world (see Reed, Newman, Suarez, & Lewis, 1997, for a discussion of positionality). They offer opportunities to transform social work as we know it into social justice work through the democratization of the processes of knowledge development and the promotion of new forms of partnership and participation. In short, we need a fundamental rethinking of to be nature and direction of social work practice as we come to grips with the rapidly changing environment in which we live and work. 5. There have always been power relationships and the impacts to the K have not led to extinction there's no brightline in the meantime, immigrants are going without healthcare and dying 6. Alternative fails <insert card> 7. Case outweighs the Kritik 8. Alternative doesn't solve case case becomes a DA to the Kritik

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