In all the controversy about the proposed new health plan and its extension to illegal aliens, one question is never raised: Why haven’t illegal aliens, many of them employed, young, and healthy, simply bought private catastrophic plans — and are they presently really uninsured?

The presumption is that poverty precludes purchase of a plan. But $50 billion in remittances go to Latin America and Mexico, at least at the peak in 2007. In my hometown, cell phones and nice cars are evident at the emergency-room environs, as I can attest from a few visits for a broken arm among other things.

In other words, the choice not to buy hospitalization insurance in many cases is one of discretionary spending: Someone decides to buy a cell phone, or send $400 a month back to Mexico rather than buy into something like a catastrophic plan from Kaiser for $300 a month, because 1) he is young and relatively healthy; 2) there is usually a federal or rural state health clinic around that gives free routine care (many here in the central valley), or an emergency room that offers free emergency and catastrophic care; 3) a decision is made to save money from buying such insurance in order to divert it to relatives in Mexico on the expectation that others in the United States (many of them lower-middle class taxpayers) will make up the difference and subsidize free health care for illegal aliens if the need arises.

Before we get into an acrimonious debate over the ethics of extending health care to a new constituency, we should understand that the ethical question cuts both ways, and that millions illegally here have already made a deliberate decision to subsidize millions in Latin America and Mexico (to the great relief of their governments) on the presumption that they in turn will be subsidized by millions of taxpayers here. I am not sure it is such a moral thing for an elderly person to worry about Medicare cutbacks so that funds could be diverted to extend health-care coverage to younger illegal aliens, so that they in turn can continue to send billions home. Even stranger, to a large extent that is already happening: We talk about the “uninsured,” but almost daily in Central California, a car accident or an act of violence or a work-related injury sends a Mexican national without documentation to the emergency room — and hundreds of thousands of dollars of necessary, but free, catastrophic care to be picked up by the taxpayer.