Health Care and Language Access

Health Care and Language Access November 16, 2014

That yesterday, November 15, marked the start of the open enrollment period for the health insurance marketplace is a well-known fact at my current place of work, which may be about the only place in America where terms like “health insurance marketplace” or even “Obamacare” have little or no political connotations.  They may elicit groans, but not for the reasons you might expect: for me and my coworkers as telephonic interpreters, what these terms primarily bring to mind is long and often tedious phone calls.  Yet if I am to approach my work in any way as a ministry, I would  do well to remember the larger principle at stake in the provision of language services, namely that of access to essential services for minority-language populations.

Health insurance is of course only one part of this picture, and I’ve written about the same general principle from another angle once before.  Now as then, a couple of news items via the American Translators Association caught my attention for their intersection of linguistic and social concerns.

The first of these indirectly demonstrates how the question of access is particularly prone to get lost in the politically charged and often knee-jerk debates between Obamacare supporters who are so preoccupied with defending it at all costs that they are frequently tempted to gloss over its flaws, and its detractors who have made the impassioned and unequivocal fight against it a cause célèbre for its own sake.  The debate often rages over the heads of people who fall through the cracks in the system – and from what I’ve observed, the system is indeed pretty cracked.

Here is the language access problem in health insurance described in a recent Washington Post article, as summarized by ATA Newsbriefs:

Approximately 115,000 people will lose the coverage they recently purchased through the federal health insurance marketplace because they failed to provide documentation proving they are American citizens or are in the U.S. legally. The Department of Health and Human Services (HHS) has sent multiple notices warning of the deadline and consequences. Immigrant advocacy groups say that since the notices were only provided in English and Spanish, individuals speaking other languages would have been unable to read the warnings. The groups have collectively filed formal complaints with the Office of Human Rights, stating that the HHS failed to meet the language needs of those buying coverage and is in violation of the Affordable Care Act’s nondiscrimination requirements. The complaints acknowledge that the alerts included taglines in several other languages notifying recipients of available interpreter services, but those taglines did not warn them they were in danger of losing their coverage. One complaint filed by an organization serving Asian communities reports that the taglines were not translated in many of their clients’ languages, including Burmese, Lao, Nepali, and Indonesian. The advocacy groups say they previously requested HHS officials to provide more substantial translations for critical health insurance-related notices, but to no avail. Karen Tumlin, an attorney at the National Immigrant Law Center, says the goal is simply to have non-English speakers given a fair chance to fix any problems they might have. “What we’re asking for is so minimal in that sense that it doesn’t have to be necessarily a translation of every single word,” she says. “What we need in these other languages is one to two sentences.”

From “HHS Is Kicking Immigrants Off Obamacare Coverage Without Fair Warning, Complaints Allege”
Washington Post (DC) (10/01/14) Millman, Jason

The minimal scale of these immigrant advocates’ goal is notable here.  Asking applicants for documents proving their immigration status is itself a reasonable request.  And it is equally reasonable, in turn, to expect that this request be communicated in a way that allows for adequate understanding of what is required and “a fair chance to fix any problems”.  I can personally attest to the existence of communication gaps here, since the company I work for often ends up filling in those gaps: I can’t count the number of calls I’ve received from both the marketplace and various insurance companies with customers who have received notices they don’t understand, or who need help untangling unduly complicated situations even after providing all the requested information.

Another item in the same news briefing caught my interest for a similar reason, relating more directly to doctor-patient communication, particularly in New York City hospitals, which I communicate with on a pretty much daily basis (often multiple times a day).

With a Chinese patient population of approximately 30 percent, the New York Hospital of Queens has launched a monthly health education series for native Chinese-speakers. The lectures are part of the hospital’s Community Health Initiatives program. While local leaders have praised the hospital for going beyond basic language access rights, the program is also a reminder of how much is not being done in other communities. More than 1.8 million of New York City’s 8 million residents have limited English proficiency (LEP), according to the Mayor’s Office of Immigrant Affairs. The Joint Center for Economic and Political Studies reports that the LEP population is underserved in healthcare and that the resulting inequalities come at great expense to the economy. Gayle Tang, Senior Director of National Diversity and Inclusion at Kaiser Permanente, agrees and says, “Organizations, leaders, and decision-makers really need to understand that language access is a business imperative, not a minority issue.” Language access advocates also point out that patient education is just a small piece of the bigger picture. Researcher Cindy Brach of the Agency for Healthcare Research and Quality says the problem requires a multi-pronged approach, including availability of healthcare information in a patient’s native language, medical interpreting services, and translation of discharge instructions. Experts cite interpreting services as an example of how difficult it has been to make progress. Although a 2006 law mandated free language services in the city’s top six non-English languages, there is still a significant difference in how the law is being carried out, especially in access to interpreters. New York Immigration Coalition Advocate Claudia Calhoon says even getting healthcare providers to consistently use interpreter services is a challenge. Tang remains hopeful, however. “It’s a matter of people getting together and being able to leverage each others’ resources,” she says.

From “Healthcare in Translation”
NY City Lens (NY) (10/20/14) Lem, Pola Aniela

I chafe somewhat here at the stronger emphasis put on the almighty economy above the need for vulnerable populations to be able to communicate with care providers, as in the quote stating “that language access is a business imperative, not a minority issue.”  Actually, it’s both.  If Tang had said, “not only a minority issue”, I would agree.  To be fair, it’s entirely possible that that’s what she meant, and that she was trying to persuade people from a business angle who may not be as easily persuaded by a moral one: well and good.  For Catholics, however, it is important to remember that from the standpoint of our Church’s social teaching, human needs – especially among the most vulnerable – must come first.  Not that economic concerns are necessarily unrelated, but they are secondary.  As Pope Francis likes to remind us, it’s when the economy becomes detached from consideration of human dignity and is considered rather for its own sake that it becomes an idol.

One more point should be addressed on the subject of language access for America’s many minority-language residents.  Some will surely mention the duty of expatriates to learn the language of their adopted home, and indeed rightly so: these concerns are not contradictory but complementary, not least because of the strong desire among these same foreign-language populations themselves for the empowerment that comes with learning English.  I would not want to be such a blindly biased advocate of language services as to dismiss the education that is surely the most empowering thing in the long run.  Nor, by the same token, should these services be feared as a disincentive to that education: having to rely on an interpreter is still a vulnerable position to be in.  No language service can eliminate the vulnerability of living with a language barrier; they can only mitigate it.  And it must be mitigated in the meantime, because nobody can learn a language overnight, and there are plenty of people who can’t afford the time it takes to do so before learning how to keep from losing their insurance or what medical treatment to follow.

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  • David Cruz-Uribe, SFO


    thank you. You have really captured the subtle problems involved in being a member of the english as a foreign language community in America. I have experienced it from the other side: I speak enough Spanish to get by: I can order in a restaurant, get a hotel room, etc. But should something go wrong (e.g., a loud persistent noise in my hotel room) I quickly discover how frustrating it can be to not really be able to speak the language. And this is something relatively minor—I learned in the end I could control the noise by closing the door to the closet, which was enough until a checked out a day or two later. Based on this I can only begin to imagine how much worse it would be if it was a matter of more urgency or importance.

    But at the same time, I want to raise a caution to your turn of phrase

    “Some will surely mention the duty of expatriates to learn the language of their adopted home, and indeed rightly so”

    I am less sanguine about this conclusion, if only because, at least here in the US, there has always been a tension between English as the hegemonic language, and the existence of other self-sustaining linguistic communities. I think particularly of German, which until WW I had a large community of speakers, including a vibrant press, churches, schools and social organizations. Despite the bigotry and opposition of the English language majority, it was quite possible to live and indeed prosper while never being able to speak English. So I could envision (especially given their rapid expansion and historical presence in many places) that immigrants from Spanish speaking countries might continue to only or predominantly speak Spanish. This comes with a price, but I am not ready to say that they have a “duty” to avoid this price by learning to speak English.

    Maybe this is only decentraliziing relativism, but I think this needs to be posited in opposition to the jingoistic nativism that underlies much “English Only” or “English First” posturing. To avoid problems, let me hasten to say that I am NOT accusing you of this in any way. I am just concerned that in addressing a real problem you are yielding too much rhetorical ground to those who do hold such positions.

    • Julia Smucker

      Thanks for your thoughtful response, David. And off we go into the tangled web of sociolinguistics.

      I wrote the above anticipating pushback from the other direction and wanting to acknowledge that there are good and bad reasons for encouraging dominant-language acquisition. My intention was to validate the empowerment rationale and NOT the nativist one, and I very much hope I did not overshoot the mark on that point. It was also partly in anticipation of nativist stereotypes that I pointed out that, for the former reason, there is often a strong desire to learn English anyway.

      You are right, though, about the tension between dominant and minority languages, which must be navigated with care, since the tension includes such valid concerns as empowerment within society at large on the one hand, and cultural & linguistic preservation and supportive communities (in short, the dignity of peoples) on the other. And to complicate matters further, both concerns can be abused in disempowering ways, intentionally or not. Previously while addressing a similar set of tensions in a different context, I thought of the pitfalls involved as the melting pot vs. the ice-cube tray. Or one could call it a dilemma of assimilation vs. isolation, neither of which is ideal.

    • David Cruz-Uribe, SFO

      Julia, you are right that there are extremes in both directions that do not do justice to the underlying communities, though I would not want to treat them as symmetric. (This should sound familiar coming from me!) I have spent a fair bit of time thinking about this both historically and internationally, motivated by being a Mexican-American who grew up speaking English as my primary and essentially only language. (My father taught me a little bit of Spanish but trained my ear so that what little I speak, I speak without much of an accent.) My travels have taken me to the Basque region and to Catalonia in Spain, where ethnic identity is very closely tied into language. This close connection was reinforced by Franco’s chauvinist attempt to equate “Spanish” (as a national identity) with Castillian (the dialect of “Spanish” spoken in Spain), and his often brutal attempts to suppress competing languages on the Iberian peninsula.

      I think the US, however, has the unique problem that ideology has trumped history, and there has been an almost wilful forgetting of the existence of minority linguistic communities throughout the history of the US. Despite substantial evidence to the contrary, their is an unreflexive belief that “our” ancestors came to America, shortened their names and all spoke perfect English by the second generation. The Mexicans in the southwest and the francophones in Louisiana and northern New England are eliminated or ignored in this view, along with other groups.

      What I think your post nicely illustrates is the response I find best: the dominant linguistic group (English speakers) needs to acknowledge and actively support communication across the linguistic divide to minority language groups. What remains for further consideration is how to respond to a growing group (Spanish speakers) who are rapidly becoming such a large and self-sustaining group is so many parts of the US that the assimilationist model no longer makes sense. I this case I would look to the Swiss model, where the majority is literate in at least two and often all four of the official languages of the country (German, French, Romansh and Italian). The prevalence of Spanish in many elementary schools is a small but significant step in this direction.

      • Alexandra

        Your post truly concerns me because of the attitude it seems to demonstrate.
        You state that you speak very little Spanish. Do you speak enough of any other language to interact sufficiently closely with enough of this apparent multitude of foreign-language speakers to be able to state with such certainty that they choose not to learn English?
        The fact is that study after study shows that by the 2nd generation, English is usually the dominant language.
        The fact is that learning a new language is not easy — note your lack of proficiency in Spanish (which someone in your family must have spoken at some point in time and which is taught in almost every high school in this country). It is even more difficult to learn a new language when one is older. It is yet more difficult to learn a new language when one is working 10-12 hours a day and then taking care of one’s family. It is yet more difficult to learn English when one is functionally illiterate in one’s own language.
        The fact is that there is a lack of a sufficient number of ESL programs.
        The fact is that many (though by no means all) of the ESL programs that are low-cost or no-cost are not very good.
        I came to this country as a baby immigrant. I have lived all of my life in direct contact with immigrant communities. I have spent the last almost 25-years of my life working directly with immigrants from many countries. I have spent several years teaching an anthropology course about immigration at a local college, so I have done some reading on the topic of immigrants and acquisition of English.
        There are very, very few people who do not want to learn English. Many are fearful; many are limited by circumstances. Rest easy: although many immigrants are far more comfortably speaking their own language, the vast majority do their best to learn as much English as hey can as soon as they can do so.

        • Mark VA


        • David Cruz-Uribe, SFO

          Alexandra, please read my comment more carefully. I never said that they didn’t want to learn English currently. I was commenting on the historical fact that there were large, self-sustaining linguistic minorities for whom learning English was not a priority: e.g., the Germans in 19th century Wisconsin went to the mat for German only schools for their children. Now in fact a variety of factors led this community to change its position, albeit gradually, but I was pointing this out to suggest that the nativist “melting pot” model was not true in the past (without making a lot of exceptions and complications). Based on this, I was speculating what might (and perhaps should) happen in the US as the Spanish speaking minority edges towards a plurality. Will social and economic forces become such that just as current Spanish speakers have incentives to learn English, anglophones will have incentives to learn Spanish, moving us towards two dominant languages?

      • Julia Smucker

        All good and interesting points, David. I definitely agree on the importance of history; I think the way I would phrase the problem you’re pointing to is that ideology has a stubborn way of shaping historical narratives.

        I wish it were easier to imagine what it would look like for America to actively embrace linguistic diversity, as this could be really enriching. And, don’t hate me for this, but as the above articles demonstrate, it also needs to be acknowledge that other forms of bilingualism do exist in addition to English-Spanish (yes, even in America). Of course it’s only natural that the latter looms largest in the national consciousness, but I was also thinking of other language groups with an even more liminal place in society. Not to suggest, of course, that it’s by any means an either/or! 😉

        • Julia Smucker

          As an addendum, another couple of (somewhat paradoxical) work-related factoids are illustrative of this country’s linguistic makeup. On the one hand, between four contact centers and a number of independent contractors, I’ve been told we serve somewhere around 200 languages total. On the other hand, all but one are referred to by a category known as LOTS, an acronym for Languages Other Than Spanish.

        • David Cruz-Uribe, SFO

          No Julia, I could never hate you for pointing out that something is not dichotomous! Exasperated, occasionally, but no hate involved. 🙂 I agree that there are lots of other language binaries active in the US and they all need to be accommodated. But I think Spanish is unique just for the size of the spanish linguistic group. But even here the Swiss model has something to say: the Romansh speakers are a very small linguistic minority in Switzerland, being heavily represented in only one canton. Recognizing Romansh as a “national” language seems to have been a concession to this regional fact. (I wish I knew more about this, as I find the whole process interesting.) Since there roughly (as a percentage) as many Chinese speakers in the US as there are Romansh speakers in Switzerland, one could envision Chinese linguistic “cantons” in the US.

          But this is all futuristic hypothetical. The real problem of welcoming the stranger who does not speak English (or does not speak it well) continues to loom, and your post is a timely reminder of what that entails.

  • Mark VA


    As an ESL, I congratulate you on a beautifully balanced line of thought – everything you wrote clicks, logically and aesthetically. Whenever I come across this caliber of thought, Mozart’s music starts playing in my head, thus I award you the KV-525-IV prize:

    Mr. Cruz-Uribe:

    Please forgive this unsolicited advice: I hope you will consider a timely remedy for your, how shall we say this, “condition”? Don’t go thru life, for all practical purposes, monolingual. Think about the plasticity of the brain, and its surprising benefits.

    • David Cruz-Uribe, SFO

      Mark, your advice is welcome. Truth be told, I speak three other languages (French, Spanish, Italian), albeit not well (a euphesim for badly). I only practice them regularly when I travel. It is a running joke to my colleagues in Spain: they say (in Spanish): “Your name is Cruz-Uribe, of course you speak Spanish!”

      • Mark VA

        Thank you for your gracious reply, Mr. Cruz-Uribe.

        If I may press my luck, and for what it’s worth, my definition of bi-lingual (or multilingual) is to be able to think in both languages equally fluently. They should also feel equally native. This then brings on a new set of interesting questions about the nature of comprehension, meaning, etc.

        Now that we know more about brain plasticity, these philosophical questions about the mind can be better connected with the material world of our brain.

        • Julia Smucker

          A more (linguistically) technical definition of bilingualism does not require equal fluency. Otherwise relatively few bilinguals could be defined as such, and still fewer if you insist that they be “equally native”. It is impossible by definition to attain native fluency in a non-native language. But that does not mean that bilingualism cannot be acquired with different degrees of fluency.

          To make it personal, if your definition applied, I (and probably most of my colleagues) would not have a job.

        • David Cruz-Uribe, SFO

          Well for my part, I define my abilities by saying that I am equally incompetent in all the languages I speak.

        • Mark VA


          I didn’t make it clear that I wasn’t thinking about second language fluency in general, but in particular – I tailor made this rather strict (but I believe, attainable) definition, for my interlocutor.

          I am puzzled by the rather low bar for second language fluency set by the technical definitions you mentioned, and would like to read more about them – could you point me in the right direction?

          Also, could we agree on this: it is well within the grasp of most SLLs, after some investment in effort, to be able to think equally well in both languages?

          • David Cruz-Uribe, SFO

            Mark, I cannot speak from experience, but I have a colleague who studies Japanese history. He has lived in Japan, is married to a Japanese woman, and is by most ordinary standards, bilingual. He readily admits that he does not have native fluency, and says that to get it, he would have to live in Japan for many, many years, communicating only in Japanese.

        • Mark VA

          Mr. Cruz-Uribe:

          Your colleague’s thinking correlates closely with my experience. I was thinking primarily of my fellow immigrants, who do have the luxury, and the opportunity, of communicating almost exclusively in English – if that’s what they choose to do.

          For what it’s worth, this is my position on the immigrants’ obligation to learn English:

          It promotes linguistic unity, without diminishing the fun of diversity. It helps to increase the love neighbor. It helps in multiplying one’s talents. It honors the great principle and promise of “E Pluribus Unum”. We now also know it benefits the plasticity of the brain.

          Finally, the late and great Jaime Escalante lobbied against bilingual education, thus promoting true bilingualism – Spanish and English, in this case, not the fake Spanish only “bilingualism”:

        • Julia Smucker

          Sorry for the late response, Mark, but I did want to reply to your query.

          First to clarify one point: I take it the “low bar” you’re referring to is in terms of who can be defined as bilingual. This is a different question from that of fluency, which is a matter of degrees. So David, according to his self-description, could be called functionally bilingual without being fluently so.

          I’m wondering if by conflating bilingualism with native fluency you are setting the bar too high for the former and too low for the latter. You’re raising interesting questions about the degrees of fluency attainable, which is difficult to measure objectively, but I think it depends on more than just effort. Prolonged and immersive exposure is undoubtedly important. Age is also widely considered as a factor related to the plasticity of the brain you keep mentioning, although not an absolute one, as my own experience tells me. In any case, I have to add, without knowing the circumstances of your own language acquisition that you allude to, I never would have guessed that you were not a native English-speaker.

          Anyway, to get to your question, I wish my memory was clearer on previous reading. I do recall reading this fascinating book several years ago; it’s a bit thick in volume but quite accessible, as well as reputable.

          And then there’s a blog called Language Hat that I used to visit regularly; its content is random but interesting, with a good collection of resources in the sidebar. I did find this 10-year-old post there based on a similar discussion to the one we’re getting into here.

        • Mark VA

          Thank you, Julia, for your response.

          Thinking about language acquisition, I wonder if its proper measure is just fluency, and not the less precise categories of native, or first and second language. I also get the impression that the science of language acquisition is not yet well developed. Plus, I’m somewhat skeptical of those language acquisition scholars, who are not equally fluent in at least two languages. In my view, this is the minimum price of admission into this club.

          Going beyond the mere mechanics of learning another language, the habit of switching thinking back and forth from one language to another, brings on additional questions. For example, how do we comprehend an idea? While it’s obvious that comprehension is independent of a particular language, it is not obvious (at least to me) where to locate the locus of this comprehension. Calling it a “mind” helps a little, but not fully understanding its interface with the brain, this locus still remains a terra incognita.

          Going even further, we could ask if literacy is the only way to communicate with precision? We do have hints, I believe, that it may not be the only way. Take, for example, the last movement of Mozart’s piano concerto in D minor
          (Allegro Assai, KV. 466). No word is exchanged for these magical seven or so minutes, yet we know, beyond the shadow of a doubt, that when trumpets are heard at its climax, a victory has been won:

          I think that as we continue in our biological and cultural evolution, we’ll find additional modes of precise communication. But for now, as you can tell, we’re still a tribal and language bound species.

          • Julia Smucker

            I’m still not sure you realize what a rare and steep price “equal fluency” is, largely because of that distinction between native fluency and, more ambiguously, fluency tout court. (There I go code-switching out of my native language, which I guess makes for an example of how an acquired language can create or at least underscore lexical gaps in the native language that may not have been there otherwise.) The problem here is that fluency is not in fact the precise category you seem to be trying to make it. How exactly would you define whether someone knows a language fluently, let alone be able to determine equal fluency in languages spoken by a given person? I wish I had a better grasp on the range of views among linguists on this sort of question, but all I’m sure of is that there is no easy consensus even there on a precise definition of language fluency, so beware of assuming too much.

            Your final speculation on evolving beyond language sounds far-fetched to me (a challenging premise for a science fiction novel perhaps), but your musical analogies are always interesting. Regarding your question there, I would first of all warn you not to conflate literacy with language, as more than half of the world’s languages are purely oral. Music is also to some degree culturally bound and not a universal language as the cliché says, but that said, it can indeed communicate beyond language in some deeply compelling and fascinating ways.

        • Mark VA


          I’m really enjoying our conversation. Now, since you’ve sprinkled some powdered French on this kawiarnia like tête-à-tête, then please let me, in Gallic fashion, express my thoughts about those linguists who are fluent in just one language:

          To be fair, here are my thoughts about those linguistic mensch who’ve bothered to correct this deficiency:

          • Julia Smucker

            Mark, you really are de trop!

            Seriously, you might enjoy reading Grosjean. He is fluently bilingual and writes from experience and scholarship simultaneously.

  • Yolo

    Then they shouldn’t come here till AFTER they’ve learned the language.

    Worrying about reading health insurance handbooks seems to be putting the cart before the horse if these people can’t read English.

    How the heck do they communicate with their doctors?

    And if their doctors speak their language this concerns me because A) it sounds like an “insider” non-assimilating community developing within the U.S., and B) why should such an invasive beachhead community worry about insurance at all.

    If Chinese doctors are treating Chinese patients, they should probably be doing their Chinese exchanges in Chinese money, and preferably on Chinese soil!!

    • Julia Smucker

      I was wondering if Alexandra may have been somehow misreading David as speaking from the kind of threatened nativism he disavows. But now we have a clear example of that for contrast – to which I can only respond with a bit of irony (like David said, history matters).

      • Mark VA

        Please allow me to chime in too, Julia:

        • Julia Smucker

          I have to say, Mark, I’m really enjoying your musical sense of humor! Thank you for the flattering comparison too; I will try to live up to it.

      • Alexandra

        I did, indeed, misread David’s initial comments, and this became clear to me after I read his subsequent response to you (which had not been posted at the time that I wrote — Disqus works in funny ways).
        I am glad that I was wrong.

    • David Cruz-Uribe, SFO

      Yolo writes “invasive beachhead community”.

      This is a provocative and revealing turn of phrase which I think says more about you than about the current realities of immigration. Why are immigrants who do not immediately assimilate linguistically (despite the real obstacles Alexandra notes in her post above) an invasion? Do you really think they are coming to destroy America, or at least your American way of life? (Which itself is an amalgam of so many previous cultural groups: chips and salsa are not sold in the “international foods” aisle at the supermarket.)

      And how does the Christian injunction “welcome the stranger” fit with this? Scripture does not say, “welcome the stranger, but only those who will become just like you.”

      • YOLO

        They don’t care what happens to America. They’re here to scoop up the bounty and send it home as residuals, with no investment in the more transcendental cultural project going on here. Many are contemptuous of Americans and loyal only to their blood back home. Their narrative is Robin Hood except they think theyre entitled to Manhattan.

        • YOLO

          *remittances, not residuals

        • Julia Smucker

          This narrative is quickly becoming a caricature of itself, and there is nothing remotely Christian about it.

          This question will probably fall on deaf ears, but I have to ask it anyway, for my conscience if nothing else: what makes those born in one country so entitled to bounty that those who expatriate there – and their families – are not entitled even to a livelihood?

        • David Cruz-Uribe, SFO

          Do you have any evidence for this sweeping set of generalizations, all of which are wrong in my experience with immigrants, including my own father, the nice Turkish couple who lives on my left, and the Indian family who lives on my right, the French Canadians two doors down and the Pakistanis up the block.

          • Julia Smucker

            I want to move to your neighborhood, David!

        • YOLO

          Remittances total in the hundreds of billions of dollars every year.

          They come to rich countries to send the money elsewhere.

          At the school I work at, we all know an additional sort of theft occurs: students come and train in engineering, medicine, etc…then skip back to India or China without ever paying the debts, effectively disappearing into a sea of billions.

          Christianity makes rules about our individual treatment of individuals. It is not a political program and to me it is absurd to take a personal virtue like hospitality and try to analogize it up to the level of the faceless State dealing with massive demographic questions.

          Our society wasn’t made to be the picking-tree for poorer and more dysfunctional societies. They need to be fruitful themselves, not living off the international welfare that remittances represent. Such dependency is a mortal sin.

          • David Cruz-Uribe, SFO

            “Remittances total in the hundreds of billions of dollars every year”

            According to the world bank, remittances from all of Latin America were just over 50 billion in 2013. You are off by an order of magnitude.

            “an additional sort of theft occurs”

            Why is getting an education (which many of them do pay for) and then going home to work “theft”?

            “Such dependency is a mortal sin”

            So, moving to a foreign land, working a menial job to support your family and then sending your wages home is a mortal sin. No, it is not, and to assert otherwise is to make a mockery of Catholic teaching.

            You cannot reduce Catholic moral teaching to individuals. We are a social people, and ethics must have a social dimension.

        • Yolo

          No, David, remittances are in the hundreds of billions:

          Who said I’m limiting this to Latin America. Asia (both China and South Asia) is a huge concern too.

          Educationis only stealing when they leave after and never pay the debt. It happens too too often. But I am suspicious of educating the populace of our rivals. Why should we give China the engineering know-how to build up a military that someday will be used against us? Why should our children’s university experience be one of being uncomfortably surrounded by Asians who refuse to socialize with anyone but their own kind and clearly have no interest in being pro-social or building up the university community? The contempt is palpable at times. And taking up spots good American kids should get.

          The State cannot “show hospitality to” a population. A person can show hospitality to a person. There is a social dimension and it’s called: Justice.

          • David Cruz-Uribe, SFO

            Thank you, I misread the data I looked at. I also under-estimated the remittances flowing to Asia. According to the World Bank, remittances from the US (which we are discussing) were $123 billion in 2012. The figure of $450 billion is all remittances from all countries to the third world, and includes large amounts from the Saudi Arabia and the Gulf States, which invite guest workers—a very different situation.

            I hunted for data on student loan defaults by international students and could not find anyone. Since until very recently private lenders were eager to lending in this market, I would assume they did not think defaults were so bad as to make the business untenable. I agree that deliberately defaulting on loans is a bad thing, but I would want to see data proving that this is a significantly greater problem for foreign students.

            The remainder of your comments about Asian students are as bigoted as complaining that all the Black kids are sitting together in the cafeteria.

  • Brian Martin

    Yolo seems to have mistaken a Catholic blog with a tea party blog

  • trellis smith

    Expatriation is not the issue Julia, but sovereignty. And the bounty you speak of is not shared but the little that is actually gotten is fought over at the lowest rungs of our society.
    The condescending elites comprised of corporatists and the internationalist cabal care little of what happens there. In a hopeful sign such condescension cost the Democrats the election. Yet the president is prepared to unilaterally offer wholesale amnesty and thus encourage open borders and total political polarization.

    It is not the taxpayers responsibility to translate any document other than that of the predominant language. A discrimination suit of this nature would compel onerous expense at every level of government,, Advocacy of such a suit is merely self serving and usher in a backlash of unnecessarily mandating English as the official language

    • David Cruz-Uribe, SFO

      “It is not the taxpayers responsibility to translate any document other than that of the predominant language”

      Why not? I really fail to see why acting in the best interests of people who are citizens or legal residents (the only people who can purchase care through ACA exchanges) is not our collective responsibility.

      • trellis smith

        Promotion of multiculturalism (an invention of the leftist elite) by the state is not in the interests of sovereignty nor for the cohesion of the nation , It is therefore not in the interest of the state to fund any initiative such as this. Language is the most significant binder of culture, The influx of many cultures and languages does not threaten the cohesion of culture so long as those cultures aspire to participate in the dominant one which is more fully achieved by the second generation,
        What private groups choose to offer in the form of immigrant services is entirely up to them. The Catholic Church in America was one such private group and a very successful immigrant service at that. The church however had an altogether different plan promoting cultural assimilation while maintaining religious identity.

        • David Cruz-Uribe, SFO

          So when the state fathers of Wisconsin ordered the draft constitution to be published in multiple languages (English, German, Flemish, Norwegian and possibly French), they were acting at the behest of a liberal elite? Multiculturalism is just acknowledging a reality that has existed in this country since its founding: along side the dominant culture there have thrived other cultural and linguistic groups. Members in these groups wanted to be American, and obeyed the law and endorsed the general principles underlying republican democracy, but did not think that they had to remake themselves into Anglo-Saxon Protestants in order to be real Americans.

        • trellis smith

          Multiculturalism as it is understood today with government promotion of other languages, mandating publication of government documents into a different languages or government funded bilingual education for immigrant children, creating a new classification of “hispanic” for protected class status, all for further purpose of resisting the normal and historic trend of cultural assimilation is very much promoted by “progressive” elitist forces who have lost confidence in their own culture to which most immigrants aspire.

          There are plenty of examples in immigrant history of the Anglicizing of surnames etc., the refusal of letting the children speak the language of their parents in order to speed assimilation etc, The capitulation to Protestantism in Vatican 2 , emanated from the American church based on large part on the cultural assimilation of US Catholics to Anglo-Saxon Protestantism.

        • David Cruz-Uribe, SFO

          “The capitulation to Protestantism in Vatican 2 , emanated from the American church based on large part on the cultural assimilation of US Catholics to Anglo-Saxon Protestantism.”

          This is such a biased and inaccurate reading of history that beyond pointing this fact out, I see no reason or grounds to respond.

        • trellis smith

          “This is such a biased and inaccurate reading of history that beyond pointing this fact out, I see no reason or grounds to respond.”
          I then won’t belabor a response as well other than to point out that in my opinion all reading of history is biased and probably inaccurate. My reading however is not false and what you state as fact is more truly opinion.

    • TS writes: ‘And the bounty you speak of is not shared but the little that is actually gotten is fought over at the lowest rungs of our society.’

      I’m not sure of what you’re referring to here…is this the imported behavior of immigrants or is this the failure of the dominant culture to accommodate the newcomers?

      TS again: ‘The influx of many cultures and languages does not threaten the cohesion of culture so long as those cultures aspire to participate in the dominant one…’

      If that were the case we would act like puritans linked to a state religion. Is it the immigrants who have brought to our nation an increase in family breakdown, single parenting, drug use and the proclivity to constantly be at war? Or has the predominant culture failed on its own accord? Please show me the evidence.

      And finally: ‘The Catholic Church in America was one such private group and a very successful immigrant service at that. The church however had an altogether different plan promoting cultural assimilation while maintaining religious identity.’

      And what is the religion of the majority of immigrants to America? Are they not Catholic/Hispanic and many Catholic/Asians?

      • trellis smith

        In chronological response, It is the inability of the present economy to adequately provide for all and the competition for scare resources and jobs that will increase the discord and overall misery primarily of the working poor.

        It is interesting that when I think of dominant culture I immediately think of Shakespeare, Hemingway, Appalachian Spring and baseball and you Ts think of family breakdown, single parenting, drug use and the proclivity to constantly be at war. And while you associate this with the dominant culture, one could counterpoise their association with immigration. Both are rather specious.

        The diminishment of the parochial school system which provided a school for citizenship for immigrant children means that this service is no longer meaningfully provided. Secondly the bishops support of amnesty and in particular the action of the president undermines the Constitution and the rule of law.

  • Mark VA


    I think that some of the points you make are valid – however.

    First: the obligation for the immigrants to learn English, and become part of the larger American community is, I believe, moral and commonsensical. Likewise, the obligation to pay one’s debts.

    However: much of the global political discourse on the issue of immigration comes across as angry and condescending. Here is a small sample (from our own country, and from abroad):

    It is difficult to avoid the suspicion that some people view immigration solely as a set of negatives: diseases, illiteracy, ignorance, breakdown of “order”, fear, costs, etc.

    How should an immigrant respond? In my view, we should adapt, learn, behave honorably, be grateful, and turn the other cheek when insulted.

    • trellis smith

      Mark, I think reasonable people can be against the level of immigration or the nature of the immigration that threatens the culture. Europe is becoming more keenly aware of the danger of maintaining its culture of western liberalism from an onslaught of Islamic immigration often in total and subversive opposition to the prevailing culture and even to the UN Declaration of Human Rights.

      Mass immigrations of any kind and anywhere are disruptive and destabilizing. The greatest fear of a nation would be to have a war that sends massive numbers of refuges across their borders, as experienced by Jordon today Governments all know the negative consequences you speak of will arise with unchecked migrations. Burma is one such example where horrific atrocities occur even among normally “pacific” Buddhists in response to unchecked immigration of poor Bengalis.

      Other negative implications and more measured consequences of the executive order of amnesty will be felt across the labor markets much to the detriment of the lowly skilled.
      The level of competition of rising populations among declining resources can only engender a less than generous response to the strangers at the gate.

      • Mark VA


        The key word is “reasonable”. I think I made it plain that immigration without assimilation is wrong – I see it as closer to colonization.

        I would like to know, if it is also reasonable to see the positive, as well as the negative, aspects of immigration.

        • trellis smith

          It would be unreasonable to not to see positive aspects. For myself what would be positive would be a reasonable level of legal immigration while illegal immigration would be negative.

        • Mark VA

          Is that it, Trellis?

  • trellis smith

    Well no Mark, my position serves as a point of departure or a base upon which can accumulate the positives and negatives of your choosing. Overall neither side can adopt the higher ground as claimed by the President. His position is more political than principled and has done us a great disservice with this manufactured constitutional crisis.

    • Mark VA

      We’ve heard the negatives, but what are the positives, Trellis?

      • trellis smith

        cheaper and tasteless tomatoes?

  • Julia Smucker

    A couple of brief responses and a larger observation.

    A question: what is it that so offends us about third-world immigrants to wealthier countries sending money home to their families? What is it that so viscerally compels us to protect the haves from the have-nots?

    An irony: if American Catholics are taking up the cry of nativist outrage, our historical memory must be getting pretty stunted.

    I do agree with Trellis Smith on one point: the president’s position is probably more political than principled (a pretty timeless statement, and underscored in this case by his pre-election punt). Which relates in a way to my larger point.

    Parts of this thread seem to be leading us to another “choose this day whom you will serve” moment. In that respect, Trellis’ invocation of the US Constitution over against the bishops is revealing. We humans are complex social beings capable of multiple senses of belonging, but where our loyalties call each other into question, there is a point at which we must indeed choose who or what has a higher claim on us. Will we serve a universal Church that proclaims universal human dignity and thus a universal right to a life that reflects that dignity, or do we subjugate the universality of the Church to the sovereignty of the State in order to claim exclusive and unmerited privileges to its bounty?

    This eve of the Solemnity of Christ the King may well be a good time to ask ourselves who our true Sovereign is.

    • trellis smith

      God alone is sovereign. The universal right to human dignity does not mean illegal and unchecked immigration that undermines the rule of law which is the cornerstone of the practical insurance of such dignity. The distortion of the moral imperative of welcoming the stranger, properly understood as a refugee by encouraging open borders simply misapplies the universal nature of the Church as universal jurisdiction. It renders the Church unto Caesar. Theocracies as such are best left to the past, unless you are prepared for another universalism such as Sharia law being applied under the same premises.

      For this and for many reasons of protecting the environment and low skilled jobs market it is mistaken as well as offensive to equate American Catholics opposition with illegal immigration as nativist sentiment. The multiculturalist, post nationalist elites of both the right and the left undermine the sovereignty and bind it to either to Lilliputian demands or nebulous unelected and unaccountable corporatist bodies with real implications for our freedom and economic well being.

      • Julia Smucker

        This is getting really convoluted, and full of straw-man arguments. You’re confusing Catholic social teaching with theocracy? What, because the Church has something to say that has social implications? You are twisting my words all over the place, and I suspect you know it. If you’ve followed me here at all, you will know that I am the first to insist that seeking to take advantage of State power is a dangerous game for the Church to play. Yet it should only be natural that as Christians (both individually and communally) we would support public policies that affirm human dignity and be suspicious of those that deny it. But let’s start with our own attitudes. How do we see the stranger among us? Is it a view informed by our Lord or by our fear?

        Your unwillingness here to see beyond the two extremes of disregard for law as such (a popular straw man) and hostility toward immigrants in general (need I remind you the original post was primarily about foreign-language speakers living in the US legally) does betray a nativist bias, which you hide behind invocation of “the rule of law”. Many are quick to do so when the law as it currently stands favors their own prejudice against some vulnerable population, whether it be immigrants, the poor, the unborn, the elderly, the imprisoned, the disabled, etc. All of these groups are vulnerable in part because the law does not go far enough in protecting them. Protection of the vulnerable, from a moral standpoint, is one of the greatest reasons that the rule of law is necessary. And by the same token, legality is not the measure of morality. If it were, we would have no grounds for opposing any attacks against the vulnerable that the law permits.

        But the law is not immutable; it can become more just or less just. And it is the duty of the Christian citizen to encourage laws toward a more consistent respect for human dignity where it is within one’s capacity to do so, or where it is not, to be prepared to suffer punishment under the law if necessary for the sake of conscience – whether in the case of medical providers refusing to perform or refer for procedures designed to kill rather than heal, or churches and charities providing sanctuary and other necessities to refugees, to name a couple of the more famously applicable examples in the United States.

        There are times when we must choose to obey God rather than men, and this is so because, as you rightly say, God alone is sovereign. You cannot at the same time, without contradiction, invoke the sovereignty of the State as having a higher claim on the people of God than God’s own commands. And make no mistake, his commands (such as we hear in today’s gospel) are not based on popular modern sentiments or whatever ideas are in vogue in any given zeitgeist, but on a catholicity as old as the Church herself, and going back even further, on the law and the prophets which hang on loving God and our neighbor (and our neighbor, as our Lord reminds us in the parable of the “Good Samaritan”, may well come from some group of people we’re inclined to consider unsavory).

        • trellis smith

          I have responded in opposition, not bad faith I could easily accuse you of engaging in straw man arguments of your own and twisting what I say to support a nativist sentiment that is unfounded. Experience in jousting with you has shown you in possession of an almost Orwellian capacity of double speak. No where have I equated church teaching with theocracy it is you who have clearly conflated the universality of the church with sovereignty. And the Church is not sovereign in this country nor as I stated in my addendum has her teachings always been a beacon of light regarding human dignity.
          I am not anti-immigrant but anti mass immigration, specifically illegal immigration. If that’s a distinction without a difference to you then let me state that one can be anti illegal immigration or even legal immigration for diverse reasons that have nothing to do with nativist or racist sentiments.

          Pro open borders and amnesty advocates attempt to claim the higher moral ground, without acknowledging that the history and complexity of this issue alone requires a more profound and possibly heartbreaking Sophia’s choice. . The President had at least the decency to do that in his amnesty speech. You make a specious claim I hide under a rule of law while in fact you run away from it ,claiming mutability you broadly dismiss laws enacted by a democratic society as unjust and think the American sense of fair play has nothing to do with illegal immigration.
          You want to distribute from the bounty of America for which the bottom rung of Americans receive little and distribute that little with the multitudes in the wings and you call that compassion and the gospel.

          Lastly these discussions are not tangential to the post but have become even more germane with current events. Multiculturalism and illegal immigration are peas in the same pod and with regards to sovereignty , ending either will fix the problem. A zealous defense of our sovereignty should be a default position, but we have become so infected especially in academia with post nationalism that despite the centuries of warnings and the example of strife within nations, we somehow hubristically think that as a nation we could not become unglued.

          • Julia Smucker

            The thing is, you were the one who brought illegal immigration into this conversation, which was originally about language service access for people with limited English proficiency who are already living in the US. The first article mentioned, on health insurance, presumes legal residency or citizenship since this is a requirement to be eligible to buy health insurance via the federal marketplace. The second, relating to New York hospitals, does not deal specifically with immigration status, but the point is that nobody should be denied necessary medical care due to a language barrier. Going on about rule of law and defense of sovereignty is a red herring here; that really wasn’t the issue until you made it the issue.

            Your comments about “bounty” really seem to be coming from a place of fear: give to some and there won’t be enough for others (ignoring that it’s at least as much about earning as giving anyway). My point about catholicity being greater than national sovereignty is that that is not a Christian attitude: we must see all people as human beings in the image of God first and foremost, and the idea of this being in any way an elitist concept is twisted and absurd. Domestic poverty is certainly a problem that must be addressed, but denying services based on language of origin is not a humane solution.

    • Very well said Julia…and who can imagine any devout Christian saying, “if they come to America they should not be allowed to hear the words of the gospel unless it is spoken in English.” True nonsense.

      But you do uncover the latent mainstream grudge of immigrants taking from and ruining our country. Now I don’t want to pile on our Brother Trellis, but he is probably in the main opinion with this earlier comment: “It is the inability of the present economy to adequately provide for all and the competition for scare resources and jobs that will increase the discord and overall misery primarily of the working poor.”

      My response is twofold. To the extent that the economy performs as such is an indictment of its failure and not its success, and the need for more concern and better guidance [specific attention given to the principle of the universal destination of goods]. Secondly, just as peace and joy are fruits of conformity to God’s plan; discord and misery are also fruits (rotten fruits) which indicate the opposite.

    • brian martin

      Amen, Julia!

  • trellis smith

    An addendum: The church hasn’t cornered the market on proclaiming human dignity. Often the light of the church is a tail light while the secular state has been at the forefront of not only proclaiming human dignity but providing for it.

  • trellis smith

    Mandating government funding of language services is a bad idea for the reasons I’ve stated which has led to a natural progression of the discussion in defense of those reasons. If private entities wish to fund such services then there can hardly be any great objection.

    My arguments are based on facts not fear and your opposition to those facts represents an ideology not based on reality most people have encountered on the ground. Of course sovereignty does not eclipse human rights, but you and the leftist elites who have embraced post nationalism, never fail to try to paint those opposed to amnesty or illegal immigration as deficient in compassion and hopelessly nativist. On the contrary the policies of amnesty and open borders advanced by the bishops whom you support under the guise of catholicity is one sided and hypocritical, as lacking in compassion for the human dignity of the legal residents of this country as they are dismissive of the Constitution that protects them.

    • Julia Smucker

      For the last time, this post had nothing to do with whether anyone is residing in this country illegally. That you are reading limited English proficiency as automatically synonymous with illegal immigration is rather revealing.

      The thing you don’t seem to grasp about human dignity is that it is universal: it’s not a zero-sum game where respecting it in some means denying it to others, as if it came in limited quantities or must be somehow earned.

      It is only ideology that reflexively insists on reading everything through such stark terms as “amnesty and open borders” vs. sovereignty and the Constitution. I don’t suppose there is anything I can say to argue you out of that binary, but you might at least give the bishops a little credit for nuance. USCCB president Joseph Kurtz was just recently quoted “saying that there is ‘an urgent pastoral need for a more humane view of immigrants.’ He also called for legal measures that ‘respects each person’s dignity, protects human rights, and upholds the rule of law.'”

      What about that can be read as dismissive of anyone’s dignity? (I’m talking about Kurtz’s actual words here, not any preconceived anarchic caricature.)

      • trellis smith

        And once again Julia your attempt to malign and mischaracterize is much more revealing. For the attribution to me of a synonymous association of English proficiency with illegal immigration is only in your own head.

        If you had truly followed the thread my contention and contempt is for an elitist ideology that equates universality with post nationalism. Its expression finds itself in promotion of a strange aspiration of an unnecessary multiculturalism which is not in the interest of the state and therefore should not be supported by the state. You may deny that you subscribe to such a position but you fail to accept the implications of what you have written. and your rebuttals do not support your denials.

        The universality of human dignity once again does not mean that one is accorded the same treatment. Criminals are arrested and interdicted and incarcerated in other words treated quite differently than the law abiding but that is not to say they are forcibly treated inhumanely.

        I could only applaud what Joseph Kurtz has said but the USCCB’s support of amnesty pretty much undercuts what it actually says unfortunately. The conference finds itself oftimes engaged in doublespeak, but than I suppose that prevents it from playing a zero sum game.

        • Julia Smucker

          I suppose, Trellis, that we’ve been talking past each other rather futilely for awhile now. All I have left to say at this point is that it’s clear from the manner of your response, here and on previous threads, that you do have some strong feelings associated with this subject matter, and not merely disinterested facts as you claim. But having strong feelings is not itself a bad thing. I only wish you would examine their source. Our immediate reactions such as moral repugnancy can tell us a lot if we allow reason and emotion to inform each other.

    • Julia Smucker

      On an additional technical note, the private sector also interacts with federal and/or state laws. The company I work for is a for-profit corporation, some of whose clients (especially hospitals) are legally required to provide language services. And I would hope there can be no great objection to the need for doctors and patients to communicate with each other.

      • trellis smith

        The legal mandate is what is unnecessary not the need to communicate.

        • Julia Smucker

          So is there a way to ensure the necessary communication across language barriers without it being legally enforceable? I mean this as an honest question.

        • trellis smith

          I can’t think of any organization such has a hospital that would have a more compelling interest. Such communications are in the best interest of the hospital if only from the aspect of malpractice.

  • trellis smith

    @Mark “If I may press my luck, and for what it’s worth, my definition of bi-lingual (or multilingual) is to be able to think in both languages equally fluently. They should also feel equally native. This then brings on a new set of interesting questions about the nature of comprehension, meaning, etc. ”

    I too subscribe to this strict definition, while I have a knack of acquiring a utility of languages when I find myself abroad for a period of time only three acquired before I turned 20 share this characteristic of thinking in the in the language . I however have little simultaneity between languages and so while I can switch easily enough between them I cannot readily translate between them. It is a skill I admire.
    I find the various techniques for the acquisition of language quite fascinating
    not fluency so much but undetectability or as you say “native”. For myself I used popular music to get the cadences of the language and in singing with the inflections of a popular artist I found immensely helpful. Secondly the best way to acquire a native fluency I found is to find a lover native to the language as eventually you will need to speak to one another and you will always have a coach and advocate. I suppose that is the immersion method.

    I am curious as to what is your first language.