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Unlike big governments, small community hospitals cannot run deficits forever. The Copper Queen's shortfall from treating illegal aliens grows each year. This year it will be about $450,000, bringing the total for the past few years to $1.4 million. With each money-losing year, a tiny piece of the 14-bed hospital dies. When that happens, the entire community suffers. Dickson's most agonizing decision came when he was forced to shutter the long-term-care unit. "It was the only place the elderly could go," he says. "If someone had dementia, we had a room for them." But no more. Now if people who spent their life in Bisbee need elder care, they must leave the area. "The more free care we give," Dickson says, "the more we have to ration what's left."
Dickson emphasizes that not all the free care is going to illegal aliens passing through on their way to other states. About half goes to Mexicans who use the Copper Queen as their personal emergency-care facility. In effect, the hospital, which performs general surgery, has become the trauma center for that stretch of northern Mexico. If an ambulance pulls up to the border-crossing point near Bisbee and announces "compassionate entry," the border patrol waves it through, and the Copper Queen is compelled to treat the patient. It is one more program that Congress mandates but does not pay for. "If you make me treat someone," says Dickson, "then you need to pay me. You can't have unfunded mandates in a small hospital." Although the Medicare drug act that passed last year provides for modest payments to hospitals that treat illegal aliens, Dickson says there is a catch that the U.S. government has yet to figure out. "How do I document an undocumented alien? How am I going to prove I rendered that care? They have no Social Security number, no driver's license."
The limits of compassion are also being tested on the Tohono O'odham Nation. About twice the size of Delaware, the tribe's reservation shares 65 miles of border with Mexico. Like the residents of the small Arizona towns just to the east, the Native Americans, many of whom live without running water and electricity, are overwhelmed. The Nation's hospital is often packed with migrants who become dehydrated while crossing the scorching desert, where summertime temperatures reach upwards of 110°. The undermanned tribal police force helps the border patrol round up as many as 1,500 illegals a day. "If this were happening in any other city or part of the country," says Vivian Juan-Saunders, Tohono O'odham chairwoman, "it would be considered a crisis."
Yet the highest levels of the U.S. and Mexican governments have orchestrated this situation as a kind of dance: Mexico sends its poor north to take jobs illegally, and the U.S. arrests enough of the border crossers to create the illusion that it is enforcing the immigration laws while allowing the great majority to get through. Local lawmen like Jim Elkins and Larry Dever have learned the dance firsthand, and their towns and counties have to pay for it.