There is certainly no shortage of irony in the debate raging across the country on healthcare reform. For me, though, the choicest bit of irony has to be the new rallying cry of those who want to shoot down any reform efforts -- that it would provide insurance for illegal immigrants. This irony is lost on those who don't know their history, though. Because fear of immigrants is what started the concept of "public health" in America. But back then, it was fear of sick immigrants infecting everyone else which drove the debate. Hence the irony.

A century ago, what once had been a radical new idea had largely been accepted as scientific truth -- the "germ theory" of disease. Germs (or, more properly, micro-organisms) caused disease -- it sounds simple today, but back then it was a fairly new notion. With this new understanding came a better grasp of how diseases jumped from person to person. Whether through the air, through water, or through touch, these tiny germs passed from a sick person to infect a healthy person. As I said, this all sounds pretty basic now.

But as well as the budding science of microbiology, germ theory also drove public policy. The concept of "public health" was transformed as a result. Because germs don't care how much money you have -- they are the ultimate in non-bias. They'll infect anybody. Which meant that the wealthier members of society had a new vested interest in keeping the poorer members healthy -- to stop communicable diseases in their tracks.

This wasn't just do-gooder-ism, either. Domestic servants of the wealthy prepared food, tended children, nursed, and cleaned for the privileged members of society. Meaning they both existed (for at least part of their day) under the same roof. So there was more than just a hint of self-interest in attempting to keep all members of society healthy. Mary Mallon drove this point home. You may wonder who Mallon was, because you don't recognize her name. But you do know her, by her tabloid name: "Typhoid Mary." The sensational case Mallon represented drove the point home to the public 100 years ago -- servants can unknowingly kill members of your family, even if the servant appears fully healthy.

What followed in the decades to come were public health missions to the tenements and slums. And, later, building codes which dictated proper sanitary facilities in kitchens and bathrooms. Public health improved as a result, and life expectancy went up.

But things weren't so different a century ago as they are now. Immigrants entered America, took the cheapest housing (tenements and slums), and worked the least-desirable jobs (such as being servants). And fear-mongering surrounded immigrants the same back then as it does today, although the face of the immigrant has changed a bit in the intervening years (Mary Mallon was born in Ireland, for instance). But back then, the fear-mongering did some good, by cleaning up the worst asepsis in the inner cities, and introducing the concept of hygiene as a desirable thing for all.

Today, it seems, the fear-mongering has turned completely around, because now some are saying: "We don't want to pay for healthcare for illegal immigrants!" But I wonder whether that will change, when you add to it the media's perennial cry of "Wolf!" on whatever disease is supposed to kill us all next month. SARS came and went, Asian bird flu likewise made a splash in the headlines, and this year we're supposed to all quake in terror over swine flu. Now, I'm not saying that these diseases shouldn't be respected by public health authorities, but when the media gets involved all perspective immediately gets thrown out the window in favor of sheer sensationalism. If you need proof, consider that in an average year 36,000 people in America die from the flu. Every year. And there are no headlines or screaming scare-mongering about it at all. SARS, Asian bird flu, and swine flu combined have not caused as many deaths in America as the average yearly flu numbers. But facts like these are almost irrelevant when it comes to the media's behavior. Which is why I used the "cry wolf" metaphor in the first place.

But I wonder, how much of a nudge would it take to get people scared about illegal immigrants spreading disease to average Americans? It already happened when swine flu first appeared on the scene, with politicians advocating closing the border with Mexico. If swine flu returns to the headlines with a vengeance, these calls will likely resurface.

The fact is almost all of us have some sort of contact with immigrants (and remember, germs don't care whether they are documented or not). Do you eat out at restaurants? Guess who is cooking your food and cleaning the dishes. Do you have children in school? Guess who they're rubbing shoulders with during the day. Are you fortunate enough to have a nanny, a gardener, a cleaning lady, or any other "help" around your house? Maybe not, but the last three questions cover just about everybody: Do you go to the grocery store? Do you buy produce? Do you buy any farm products at all? Virtually nobody in America lives in some sort of "immigrant-free bubble."

I don't mean to be engaging in fear-mongering myself here, but it's easy to see without looking too far (as Bob Dylan once wrote) that public health concerns everyone. And excluding a portion of society for any reason is penny-wise and pound-foolish. Do you really want to limit, for instance, vaccinations only to people who have legal documents, or would you rather everyone get inoculated? Remember, those you exclude will likely have some sort of contact with either you, your kids, or the food you eat at some point. So you are gambling with your own health as well as those "illegal immigrants." Once again, germs do not care how much money or how much status you have -- they'll infect anyone.

Now, I'm not arguing for or against any particular healthcare reform plan in this article. I'm not addressing a lot of tangential issues, I fully realize. And I am not trying to scare anyone, merely pointing out the arguments which may be used by people who really do want to scare you. With the media already trying to scare everyone on the swine flu story, and with the anti-immigrant position on full display in the healthcare reform debate, such fear-mongering seems a logical next step for someone out there to take. Because the entire concept of public health was begun on fear -- fear of infectious disease. And while the fear-mongering is currently running towards saving some money on healthcare reform by denying any of it to illegal immigrants, I can see it changing course fairly quickly with a few stories in the next few months about people dying of swine flu. Do you really want to deny the kids in your daughter's class at school a flu shot, to save a few pennies? Really?

Cross-posted at The Huffington Post

-- Chris Weigant