Developing World's Parasites, Diseases Enter US

reporter alerts us to a story up at the Wall Street Journal on the increasing prevalance in the US of formerly rare, 3rd-world diseases such as toxocariasis, chagas, and cysticercosis. Health-care legislation pending in the House calls for a full report to Congress about the threat from this cluster of diseases, termed "neglected infections of poverty." "Parasitic infections and other diseases usually associated with the developing world are cropping up with alarming frequency among US poor, especially in states along the US-Mexico border, the rural South, and in Appalachia, according to researchers. Government and private researchers are just beginning to assess the toll of the infections, which are a significant cause of heart disease, seizures and congenital birth defects among black and Hispanic populations. ... 'These are diseases that we know are ten-fold more important than swine flu,' said [one] leading researcher in this field. 'They're on no one's radar.' ... These diseases share a common thread. 'People who live in the suburbs are at very low risk,' Dr. Hotez said. But for the 37 million people in the US who live below the poverty line, he said, 'There is real suffering.'" Update: 08/23 16:55 GMT by KD : The submitter pointed out that the usual "Related" link to the original submission was missing on this story. We are testing a new version of the story editor and this was probably caused by a bug; reported. Here's the original.

Comments

Evil Hollywood plot

[oldhack]

to jack up the rating for House MD. Pathetic, really.

The US isn't all first world.

[girlintraining]

People are surprised by this? Our inner cities are rotting. Our economy is in shambles. People are living squallor and poverty on an unprecidented scale in this country. We're a breeding ground now for all manners of disease, both social and medical.

Re:The US isn't all first world.

[timeOday]

Well, half the voters don't even believe in public health. If the carriers of an epidemic are deemed unworthy of health care, the free market solution is to wait until everybody gets it, then treat those with money. Ultimately that costs vastly more than stamping it out in the first place, but at least nobody gets healthcare they didn't deserve, and isn't that the most important thing?

Re:The US isn't all first world.

[couchslug]

"People are living squallor and poverty on an unprecedented scale in this country."

Bullshit. We are not near the poverty levels of the Great Depression, and the impact of poverty is greatly mitigated nowadays.

Our bitter refusal to control our borders ensures the human carriers of "Third World" diseases are free to circulate.

Re:The US isn't all first world.

[Anonymous Coward]

Lack of government healthcare != able to get help. It simply means that things are more expensive for those without healthcare in the short term if they need it.

No money = unable to get help if no government healthcare.

It's really that simple.

Re:The US isn't all first world.

[s4m7]

Lack of government healthcare != able to get help.

Right. We all remember Bush's answer to the healthcare crisis: let them go to the emergency room. ER care is significantly more expensive than proper preventive and general practice care.

It simply means that things are more expensive for those without healthcare in the short term if they need it.

Right. 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems and 78% of those filers had insurance. Citation That doesn't just make things more expensive for those with healthcare, it makes them more expensive for policy holders, anyone who wants a loan, small businesses, investors, and stockholders. And it's not just over the short term, it has an overall detrimental effect on our nation's economic well being which continues to mount.

In general there are a lot of "reactionary" people here in the US who will go to the doctor for -anything-, heck, wasn't it just a few years ago where because of the prevalence of people geoing to the doctors for every little thing was going to create more drug resista lnt illnesses?

it's not people going to the doctors that causes drug resistance, it's the repeated treatment of the same bacterial infections with a broad spectrum of antibiotics. This has a lot to do with tort liability, a subject I'm not as well versed on as I would like to be. I do think that tort reform should be a part of any comprehensive medical reform, but I think that we have to be careful.

In general, if it makes someone sick with obvious symptoms, they are going to get help here in the US. Its just the common reaction, not sure about in other countries (the US is the only country I've lived in for an extended period of time, though I have traveled to many different countries) but in the USA, a lot of people go to the doctor or even the emergency room for every thing.

"in general" is a stretch in this case. Lots of conditions can't be taken care of in an emergent care setting. This may be true for broken limbs, allergic reactions, and like conditions, but it doesn't address the situation with regard to chronic conditions, diabetes, cancer, and so on. This is the situation that most urgently needs to be addressed. If there was a law like the 1986 "patient dumping" law that applied to chronic care as well as ERs it would cost the medical industry billions. as is they are only required to "stabilize." and then they can ask for your insurance card and or show you the door.

Re:The US isn't all first world.

[timmarhy]

while you are reasonably correct on the causes of the great depression, you fail hard.

1. is over already

2. paying off loans isn't what causes contraction of money supply.

3. if you want to single out houses as the only asset, then yes.

4. yes, there's no getting away from the fact companies have taken a hammering

5. most places have had a fall in profits, there are some standouts though. gold producers are one of them.

6. here is your big fail. jobless rate in 1933 was 24.9% http://www.bls.gov/opub/cwc/cm20030124ar03p1.htm

7. here is your biggest problem - doomers like yourself who are still claiming the sky is falling when their are CLEARLY signs of recovery worldwide.

Re:The US isn't all first world.

[girlintraining]

here is your biggest problem - doomers like yourself who are still claiming the sky is falling when their are CLEARLY signs of recovery worldwide.

I'm not all doom and gloom... Forty years ago we had a middle class. We don't anymore. We have rich people, and we have poor people... Just like the countries we've been shipping our jobs out to. One of the things that made America what it was is a strong middle class. That's vaporized now under the heat of globalization, and this is something that's come about because of the current economic crisis. Yeah, the economy as a whole may recover, but our quality of life will never be the same. For many people -- there will be no recovery.

Re:The US isn't all first world.

[Jeff DeMaagd]

I think the collapse of the US middle class is in large part the fault of the middle class itself. In a world of increasing sophistication, most people ignored it and didn't adapt to it, and they didn't instill into their children the importance of education. The idea that one can live very comfortably simply being unskilled labor was a foolish one that idea only worked for a generation or two. The economic hegemony of the US post WWII helped feed that idea, but part of that hegemony was sustained by malicious policies against other countries.

Maybe globalization made that middle class collapse happen faster, but an unsustainable situation like that wasn't going to stay that way forever. Closing borders to trade usually hasn't worked out well either, all that does is incite reciprocal action.

Re:The US isn't all first world.

[CodeBuster]

I do think that tort reform should be a part of any comprehensive medical reform, but I think that we have to be careful.

Which will never happen as long as the Democrats are in power. The attorneys, through their firms and state bar associations, are collectively among the largest donors to the Democratic National Committee, Democrat elected officials (i.e. Congressmen and Senators) and Democratic presidential candidates (like our current President Obama). There are two groups that you can bet the farm that Democrats won't cross: lawyers and unions (in that order). No attorney that I know of has ever supported laws which limit their ability to go to court and sue for lots of money (its like freedom of speech to them). The attorneys will fight tort reform tooth and nail and I would be shocked if Obama signs any bill, or at least any bill that actually has teeth, which puts a national cap on damages awarded at lawyerpoint.

Re:The US isn't all first world.

[Goldberg's Pants]

If preventive medicine is more expensive than the failed system you currently have in place, then why is more spent per capita on healthcare in the US than any other western country, while your system continues to be ranked as one of the worst in the world, falling far behind those who do engage in preventive medicine.

Living embodiment of less for more.

There is an old adage. "An ounce of prevention is better than a pound of cure."

Your observations of how public healthcare works are deeply, and I do mean DEEPLY flawed.

Re:The US isn't all first world.

[Brian_Ellenberger]

People are surprised by this? Our inner cities are rotting. Our economy is in shambles. People are living squallor and poverty on an unprecidented scale in this country. We're a breeding ground now for all manners of disease, both social and medical.

And worst of all, there is a massive wave of over exaggeration plaguing the country! I cannot believe this was marked as 5 insightful. Poverty and squallor on unprecidented scale? Have you heard of the Great Depression? What facts and figures are you quoting? According to the US census at http://www.census.gov/hhes/www/poverty/poverty07/pov07fig03.pdf the poverty percentage has been at between 10 and 15 percent since the mid 60s. In 1959 it was 23%, so nearly a quarter of the population was in poverty!

We're a breeding ground now for all manners of disease, both social and medical? Start with the medical. Based on what science? Tens of thousands dying of cholera is a sign of breeding disease. Random cases of strange medical ailments because people in 3rd world countries immigrated to the US is not. What is your solution, stop all immigration? As for social disease, since the founding of the country people have been complaining about various "social diseases" plaguing the US. Heck, the crazy temperance movement managed to get all alcohol banned as a cure for the various social diseases resulting from drinking.

As for the decline of America, I've been hearing it all my life. First is was the Japanese, how they were much smarter and so much harder working than Americans, blah, blah, blah. Now it is the Chinese.

And no, I hate to disappoint you but we aren't going to be the Roman Empire because I don't see any barbarians who are going to come and raze our cities. We do not decline so much as everyone else is catching up to us. And the only reason there is catching up is because almost everyone else was demolished 60 years ago during WWII. There is no fundamental reason that the US should be the sole military, economic, and political power for the rest of human history. If we were a bunch of evil jerks, the US could try and use its power to keep everyone else down. But we don't and good for us for that.

Re:The US isn't all first world.

[Mr. Freeman]

We don't have a middle class anymore? What the hell are you smoking and where can I get some?

Re:The US isn't all first world.

[PachmanP]

"If you want to make health care more affordable to have to do things to reduce the cost directly." The only way of doing that is cutting corners and reducing standards for medicine and medical equipment. That's a bad idea no matter how you put it.

Or fix stuff like my insurance company "negotiating" $900 worth of blood tests down to the $90 they actually pay the lab. If it's $90 worth of blood tests (which it is since the lab somehow stays in business), then say it's $90. That would open a whole world of people being able to get catastrophic coverage and pay out of pocket for the basics which would put people in touch with what it actually costs and provide price pressure.

As the system stands, the buyer has hardly any idea of what the seller is actually being paid. Nobody has any inclination of what the actual cost is. The insurance companies can throw their weight around and get reasonable prices, but the poor schmuck that doesn't have insurance pays MSPR. If I could pay the same "bulk rates" as the insurances companies, my medical costs, excluding anything catastrophic, would be less than what I pay for insurance.

People like to make a big deal out of free market medicine failing, but we don't have free market medicine because the actual cost has been abstracted away from so many of the consumers that there's no cost control.

Re:The US isn't all first world.

[buswolley]

ass.

If your neighbor's house is on fire, would you let your house burn down too be cause you don't want to pay for a fire department?

Health care, much like fire protection, curbs the spread of disease.

Seriously, healthcare is no different than having a standing army. It is for the national defense.

Re:The US isn't all first world.

[s4m7]

He could have started small and been successful but he bit off more than he could chew.

He repeatedly said throughout the campaign that one of his major 1st year issues was going to be health care reform, and outlined most of what has transpired here. If you voted for him because you listened to him during the election, you should have known this was coming.

I also fundamentally disagree that he should have "started small" because it's not like we have a lot of time to dick around with this. The last time major healthcare reform happened in the US was over 40 years ago. The time to make big changes is now, and no matter if he had gone big or small, the other side of the aisle was going to make it ugly for him.

Re:The US isn't all first world.

[IWannaBeAnAC]

healthcare is not a right

That is where most of the rest of the (developed) world disagrees with you. Almost all medical problems happen by chance, to some unlucky person whose dice comes up the wrong way. Why should someone be forced into bankruptcy, or left die of some treatable disease, for something they have no control over? Let me put it another way: suppose that tomorrow you are diagnosed with some rare but treatable form of cancer. Unfortunately the treatment costs one million dollars, and your medical insurance (if you have any) refuses to pay. The cancer is rare enough that, spread across the whole population, the cost of treating all cases per year is rather small. Do you think you should be given the treatment? If so, who should pay?

It is a common argument, "I'm not going to get sick, why should I have to pay for everone else's healthcare?". It works just fine, right up until the moment where you do get sick.

Re:The US isn't all first world.

[s4m7]

they already cant turn you away if you are unable to pay

Well that's not entirely true. They are in fact only obligated to provide stabilizing care for actual emergencies by the 1986 patient dumping law. Anything chronic is generally out.

I've met a few people that go there for anything, on the public's tab.

That's not exactly how it works. The government doesn't reimburse the hospital for patients who come into the ER but have no insurance. The hospital bills the patient. The patient either pays the bill or it goes to collections. If it goes to collections, and eventually the patient does pay, chances are the hospital will only see 25% of that money. The cost to the hospital of "ER Abuse" is distributed across the rest of the hospital and passed on to insurers and eventually gets paid by policy holders. So you're right to imply that the public is still picking up the tab, it's just only the insured, and not all taxpayers who shoulder that particular burden.

Re:The US isn't all first world.

[Cstryon]

My daughter had Leukemia, she passed away earlier this year. It still works fine, I still shouldn't have to pay for your health care. We got help for hers, but it wasn't all payed for, I still owe money.

But if it wasn't for those tradesmen, with a skill that they worked hard to learn, and if it wasn't for their interest in hematology, and oncology, my daughter would not have gotten the care she did.

Those doctors helped her beat the cancer, (She got sick from having no immune system, that's what we lost her from.) I truly believe that if they didn't earn that money, and say, " Hey, I worked hard to learn this, I will charge for my goods." she wouldn't have gotten expert care.

My dad was a mason for ~30-40 years. He can build a damn good wall, and a damn good house. He could build one for you. Don't you deserve shelter? Doesn't he deserve to get paid what he chooses for his skill and trade? Health care is a need, but I shouldn't have to pay for you to get it. I should be paying those men and women who work hard to learn how to treat people.

Have you ever waited at the MVD? You want those same people to choose when you can be treated?

Re:The US isn't all first world.

[spicate]

We pay more, and this creates big companies that develop drugs that get sold for less to the rest of the world - at least it sure feels like it.

Pharmaceuticals only account for about 8% of US health scare spending, and the government already funds a substantial amount of drug development. In fact, the government and nonprofit foundations already fund a huge amount of medical research.

If we can't fix medicare/medicaid we don't have a chance of building a sustainable, effective general health plan.

We don't have a sustainable private system right now either. Insurance companies are doing everything they can to reduce coverage while increasing premiums. How is this better than a public option? One thing Medicare does quite effectively is drive down the costs of care. Ask any doctor. We need a public plan to control costs.

Re:The US isn't all first world.

[Dionysus]

Those doctors helped her beat the cancer, (She got sick from having no immune system, that's what we lost her from.) I truly believe that if they didn't earn that money, and say, " Hey, I worked hard to learn this, I will charge for my goods." she wouldn't have gotten expert care.

I'm curious to why you think experts in countries with socialized medicine don't get paid.

Re:The US isn't all first world.

[jd]

France, Canada, Britain and Japan, together with America, are the top 5 leading nations in healthcare. I doubt any of them get third-world "discounts". Aside from possibly Japan, all have horribly bad eating habits - obesity in Britain isn't that much lower than that in the United States.

But let's look at the figures. Britain, PER CAPITA, has half the rate of heart attacks and spends half as much as the US. The four nations I mention pay, on average, 50 cents for every $200 spent on health-care in the US. I'm not sure about Japan, but the rest ALL manage to have public health services.

Now, let's look at the other side, competition. Britain has the NHS which is universal. It also has BUPA (private healthcare that's so profitable it can even afford to run its own damn hospitals), Standard Life, Orchid, HealthTrust, PatientChoice, AXA PPP, Essential Healthcare, HSA, Norwich Union Healthcare, General & Medical,... In short, not what I'd call a shortage.

So, go on. Tell me how a public health service would "ruin" the private insurance companies. Convince me BUPA is just an illusion. Go ahead. Persuade me that Japan is getting medicines "on the cheap" as part of foreign aid shipments to poor nations. Convince me that even those medical marvels invented in Canada, Britain or Japan are more expensive in America solely in order to recoup the costs.

Yes, the top 5% of Americans CAN pay more, and prices have been adjusted to maximize profits not availability, so cater TO those 5%. What about the other 95%? Since America has never been able to adjust the ratio, it will always be 5:95, and that means it doesn't matter what the 95% earn. The prices will simply go up because the profits are all with the 5%.

You happen to be one of the 5%. So is everyone on Slashdot, because nobody in the 95% is spending time talking. Me, well, although I'm in the top 5% as well (or I wouldn't be here), I have medical conditions which make getting insurance a real pain and which mean I spend $250+ a month to stay alive because insurance won't touch me.

I know three people with spinal injuries who would LOVE to get away with something so cheap and none of them have my earning power. They each spend more in a week than I do in a month - those weeks they have enough money to spend on such luxuries. With those kinds of injuries, most work is right out of the question, which means you either have to start off very rich OR live your life on the bread line.

Assuming the people I know are roughly representative of the population, traumatic injuries and life-threatening conditions are likely more common amongst those 95% than serious illness is amongst the 5%.

When I look at America as it exists today, I see a world that is socially backwards, something out of a Dickens novel. Britain hasn't had workhouses for the poor since the Victorian era and abolished slavery in 1770. Even the fruit-pickers in Britain have unions and have a far better standard of living than those in the "land of opportunity".

I happen to think Britain is regressive and repressed in many other ways, and that America has got quite a bit right, but American society is so.... backwards! It's barely better than it was when the Mayflower arrived. In some ways, it might even be worse - I'm fairly sure they didn't have a 1% prison population.

Re:The US isn't all first world.

[Anonymous Coward]

I had lymphoma and went through the UK system. I had paid up front through taxes, it is a type of insurance but without the profit motive. I got the best treatment from dedicated doctors and nurses. The treatment was the most up to date. I was also admitted directly onto the haematology ward when I got an blood infection. Their dedicated microbiologist cultured the infection and identified the correct antibiotic

I paid nothing at the point of delivery, there was no one from the insurance company telling me what I could or could not have.

Re:The US isn't all first world.

[oji-sama]

What (s)he said. Also, while the experts do get paid, if you really want to see that the treatment is paid completely by you, nothing prevents you going to a private doctor and paying some more. Although unfortunately some of those private treatments are also subsidized... mmmm. Perhaps one should go and get the treatment abroad...

(And nothing prevents the experts from starting a private clinic either)

Re:The US isn't all first world.

[hairyfeet]

And you think VOTING is gonna solve things? Allow me to say BWA HA HA HA HA HA HA! What country do YOU live in pal? Because in case you ain't noticed we have been "Coke VS Pepsi" for at least the past 45+ years, probably longer. Since Obama won anyway, their vote didn't matter, correct? In 4 years you can come back here and see that NOTHING has changed, just as it didn't for Bush, Clinton, Bush Sr, Reagan, Carter, etc.

You see your pissy little vote just can't compete with legalized bribery. Sorry but it is true. if we actually got the will of the people we would be out of Iraq by now, Pot would be legal, we would have affordable health care, etc. But all it takes is the head of a multinational corporation walking into an office with a blank check and yours and millions of other voters desires mean absolutely jack shit. We have been Democrat at the local and state level for damned near 100 years, don't seem to have changed much.

Perhaps you should enjoy this bit by the late Bill Hicks, who was from AR BTW, and notice the even though the man has been dead for 20 years the bit is STILL true. And I would argue that short of completely tossing out the current system and starting over it will be true 50 years from now. That is of course if the teaming masses of ever poorer people don't eventually get tired of it and burn the thing to the ground. Funny how no democracy in history has lasted for more than a few centuries. Most likely because they end up just like us-hopelessly corrupted and tilted against the ever growing numbers of the poor by the ever smaller super wealthy at the top.

Re:The US isn't all first world.

[Trepidity]

I'm willing to believe that. But it's only worth voting the Democrats out of office on that issue if there's reason to believe that it would happen if the Republicans were in power. But the Republicans controlled both branches of government, with sizable majorities, for six years, and it didn't happen. Instead, we got a ridiculous government-funded prescription drugs entitlement in Medicare Part D---the exact opposite of any attempt at cost reduction.

To argue against the current party in power on an issue in a way that's convincing, you need to find an issue on which there is some viable alternative party that has a better position on that issue.

Re:The US isn't all first world.

[jo_ham]

And, had that happened to you and your daughter here in the UK, you would have received exactly the same care, you just wouldn't have to pay for it, other than through your NI taxes, which are considerably less than US insurance premiums (when the actual cost of the premium is considered).

There are a lot a myths about universal healthcare, all of them regularly circulated by people like Faux News and the right wing shouty talk radio hosts, and Big Pharma and Big Medical who have a vested interest in keeping the US system the way it is.

The myth that doctors, nurses, researchers and other medical professions under a Universal system don't get paid properly for their "trade" (in the UK, doctors are handsomely paid for their work) is a total lie. The myth that "the government decides whether you get treated" is also an utter fabrication.

I am very sorry your daughter died and that sometimes, even with the current advances in medicine, that people sometimes can't be saved, but universal care is not the demon that the bought-and-paid for interests in the US advertise it as.

Close the borders

[BadAnalogyGuy]

Every time I turn around the US government is finding new and innovative ideas in fomenting anti-immigrant sentiment. Scratch that. The US government is using the same old tried and true methods of fomenting anti-immigrant sentiment. They steal jobs. They bring crime. They bring disease. It's the same old song and dance.

In a world of modern transportation, it is essentially impossible to screen every person who crosses into our country for diseases. The solution isn't more border patrols on the Tex-Mex border, it's better healthcare for those who can't afford it. If the at-risk groups are the border towns and poverty-stricken, it makes sense to help them rather than try to cut off the flow of immigrants.

I used to fly internationally all the time, but with the growing anti-immigrant policies of the US, I find myself having a worse and worse time traveling even though I am a US citizen. The TSA and Immigration Control have made flying a mode of travel that is completely unattractive.

Re:Close the borders

[andymadigan]

Unfortunately the "We'll fix it" attitude leads to invading other countries (Iraq). Further, you can't have a welfare state AND have uncontrolled immigration. So, you have a choice. Have a small government, no government services other than defense and lots of immigrants (that describes the U.S. pretty well for the first hundred or so years). Or, you can have roads, social security, medicare, welfare, public schools, etc. but little or no immigration.

Can we help people in other countries? Sure. Federal money (< 1% of our budget) does go to works in other countries. However, if they decide to come here illegally, the most we can provide them with is helpful transportation at gunpoint back to their own country.

If only Madagascar...

[gardyloo]

...had shut off all seaports and airports sooner.

It's the flu!

[russlar]

It's that new flu strain I keep hearing about, the H1B flu!

Re:MUCH MORE IS COMING

[MichaelSmith]

If it was easier to enter the country legally fewer people would do it illegally. Then it might be easier to apply health checks on the way in.

Talk like an infected pirate day

[Tablizer]

Aiy captain, I be gotten scurvy!

Thank God for HMOs

[MartinSchou]

Well, at least there are no government bureaucrats standing between the sick people and the doctors who could detect and treat these diseases.

USA, USA, USA!

Or something ... it is quite disappointing to see the world's richest country with what is at times the best health care in the world unable to keep simple infections and parasites from affecting a large portion of its population.

HELLO, Where has everyone been for 200+ years?

[cenc]

I am sorry. Invasive species and diseases have been entering the U.S. since the first pilgrims got off the boat with their pock infested blankets. The U.S. has always turned a blind eye to the poor dying of them, until they spread to the middle class and rich. Now congress thinks this is an emergency?

I think author of this article needs to spend sometime getting to know their American history book. The only thing that has changed is there is now more poor. How about treating that disease?

Re:Natural Selection

[sjames]

Attention social evolutionists: poor people in the U.S. have guns and little to lose. When they have nothing to lose, the bullets will fly.

Infantile death in the US...

[jeffasselin]

The infantile death rate in the US is one of the highest in developed countries.

A significant portion of your population is affected by diseases that are mostly present in third-world countries and can be handled easily with proper health care and social measures.

And some of you still think universal health care is a bad idea?

Re:Infantile death in the US...

[Anonymous Coward]

We count ALL infant deaths. Most countries don't count deaths of babies born prematurely, and some places don't even count it if they die within the first few months (like Cuba.)

Hardly a fair comparison.

Irony

[Lord Kano]

500 Years ago, Europeans came to the western hemisphere and brought all kinds of diseases that the native population had no immunity against. Now, the descendants of those Europeans are getting diseases for which they have no immunity from the descendants of the natives from so long ago...

LK

Re:MUCH MORE IS COMING

[value_added]

As a point of fact, the US allows more legal immigration than any other country in the world.

LOL. Give me your tired, your poor, your huddled masses yearning to breathe free, right?

Sorry, you're a victim of a myth. On a per capita basis, the US accepts roughly the same number of immigrants (and/or refugees) as many western European countries, but less than other countries. By contrast, Canada accept far more. Hell, I think Greece has higher immigration numbers.

And if you factor in the anti-immigrant rhetoric and attitudes prevalent across so much of the US (and the lack of such things as health care and basic social safety nets, I'd suggest that the US is hardly a welcoming place. That's been true historically and it's true today. In the past it was the Chinese, then the Irish, then the dirty Jews and Italians; today it's the Mexicans! The reason, for example, why the US has low immigration numbers and continues to spend less per capita on charitable foreign aid than most industrialised countries, is that the US simply doesn't like and has never liked foreigners, least of all when they try to immigrate. That is, until years pass and they blend into the landscape and we recognise them as citizens like everyone else.

Granted, it's a big and wealthy country. So total numbers or dollars spent are bigger. But then, so what?

As for the article, the immigration process does require a complete health check, so the issues related to the spread of infectious diseases are addressed. The problem, however, is that not everyone who comes here is eligible to become part of that process, and there is no free public health care for them or anyone else. Consider tuberculosis, for example. Mandatory screening when applying for a green card, but the rates of infection in the US go up by 20K cases per year.