To the Editor.
—Dr Schramm1 writes "By 1989, the number of citizens without [medical insurance] coverage had reached approximately 33.4 million, according to US Bureau of Census figures." The US census counts persons, not citizens.I know citizens of Chile, China, El Salvador, India, and Mexico who came to the United States in the last 3 years and who now receive long-term kidney dialysis treatment, costing over $300 000 per lifetime of the patient. Ten million immigrants and over 20 million illegal aliens entered the United States in the 1980s.Should the impact of immigration on the health care system not be discussed since the number of immigrants is expected to rise in the 1990s?
Minuth AN. Immigration and Health Insurance. JAMA. 1991;266(16):2224-2225. doi:10.1001/jama.1991.03470160056029