I want to help this train of thought along because this is interesting to me and I'd love to get a discussion going.

> Back to borders and immigration: You control your borders. You can say that drugs don't enter your country. And they won't (at scale, at least). In the USA that's not enforceable because the country is so large. Illinois can say that they ban guns. But that doesn't stop them from going to Indiana and getting them. Or Kentucky. Or Missouri.

Short of draconian measures like in China (also a very large country), which nobody wants.

> Your local change can only accomplish so much when you are against the tide of your neighbors. You can say that you want to control your borders. But your neighbors disagree. So they go around you controls and infiltrate your economy anyway. And you don't know how bad it really is. Because statistics are an approximation of a segment of a population that doesn't want to be tracked. But these people still get sick. And some costs are fixed. So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient. Because people can pay for themselves to get a blood test. You relieve your burden on the system, for the moment. But now companies charge more because they also know that certain costs are fixed and people are willing to tolerate more costs for a relatively inexpensive service. And of course, they optimize. Because there's nothing stopping them. Since you can't tell them not to do something when you can't solve the problem yourself. And here we are.

This is what I want to dig into. The heart of this argument is that publicly funded hospitals are forced to cover for those who neither contributing to the system nor are paying out-of-pocket for it.

> So your publicly funded hospitals still need money to cover their costs by people who will flee and not pay. So you privatize and offset the burden on the patient.

Are you certain the EMTALA is really the cause of the problems we see today? I agree that it made it worse, but the cost of medical care was ballooning before the 1980s. I'm not sure what it was so I'd love to hear input from you or others.

Still, you do bring up a good point: Given that you have individuals that can't contribute to the system even if they would otherwise and given that it will also balloon costs, how do we solve this?

Perhaps its a taxation issue.

I doubt this will ever get traction but I'd love to see a compromise where we replace the blanket constitutional right where "you're a citizen if you're born here" with something different but equivalent at the amendment level.

Chasing down and returning migrants--this just funds the very problematic human traffickers--is a bandaid solution; it's inefficient; and it doesn't solve the needs of both Americans as well as our neighbors.

Instead, why not just ID them on the spot--state level with RealID, to make it palatable--make them pay a fine that is effectively the cost of a tax to fund the public infrastructure; and make such an ID either the requirement of using the triage service.

Or if they're undocumented, just treat them once and give them a choice after triage: Deportation or ID.

Carelessly thought out, I think that this sets up a two-tier residency system ripe for abuse: If said "temp" residents had children, what's the status of their children, for example.