Unemployment

Ron Carey is not a crook

The former Teamsters president made a stupid mistake, but don't forget he's the guy who wrestled unions away from the mob in the first place.

Last week, Ron Carey, who served for a time as president of the Brotherhood of Teamsters, was indicted on seven federal charges, each of which could bring him five years in prison. Carey is accused of having lied to federal officials back in 1997, when the officials were investigating a fundraising scandal in the union. The fundraising, back in 1996, had been sneaky and illegal, and Carey denied knowing anything about it, which did seem a little hard to believe.

On Thursday, Carey is going to be arraigned. The indictment, in the language of the New York Times, “indirectly points a finger” at Richard Trumka, too. Trumka is the secretary-treasurer of the AFL-CIO and is said to have played a part in the fundraising scheme. But Trumka hasn’t been indicted.

The funds that were raised back in 1996 came from various sources, and I can reveal that one of those sources was myself. I have never admitted this before, but it’s true. A friend of mine was working for Carey, and told me that Carey desperately needed to raise money for a union election drive, and quickly, too, and would I help?

In a gesture of Soros-like munificence, I wrote a check for $25. It was perfectly legal (I think). And now that I have confessed my own participation, I figure that I am entitled to comment on what has happened to my money and to the union movement.

What has happened to Ron Carey, and I suppose what might happen to Trumka, strikes me as a distortion of justice. Thirty years ago the American labor movement was in pathetic shape — not in numbers or in political power (the decline in numbers and power came later) but in its integrity and honor.

Gangsters and thugs commanded some of America’s biggest organizations — to begin with, the International Brotherhood of Teamsters Union, where Mafia hoodlums had risen to power under the leadership of the notorious James Hoffa Sr. and his friends. Mafia control of the Teamsters represented what was probably gangsterdom’s single biggest triumph in America. The United Mine Workers was likewise under corrupt leadership. But, beginning in the early 1970s, a number of grass-roots reform insurgencies got underway, some of them staffed by young people who had come out of the student movement of those years.

Does anyone remember how much courage went into those reform campaigns? The gangsters and corrupt officials had come by their reputations honestly, so to speak. In the miners’ union, gangster officials arranged for their share of murders. Yet the campaigns persisted, and, in the miners’ union, Trumka, the reform candidate, eventually came to power. He and his group beamed a spirit of honesty into union preserves that had exuded nothing but darkness for many a year. (It was later, having effected his reforms in the miners’ union, that Trumka moved over to the job of secretary-treasurer at the AFL-CIO.)

Then came the reform victory in the Teamsters, in 1991, which represented an even bigger victory. Ron Carey came to power. He did a lot of good. He got rid of some of the gangsters. He led the union on a strike against United Parcel Service, which turned out to be quite a militant strike. He won, and the victory was a huge benefit for the UPS workers, and by extension for people working in similar companies, where wages have to compete. Nor does UPS seem to have suffered, meaning that everybody won and nobody lost. But soon enough Carey faced an enormous campaign by Jimmy Hoffa’s son, James P. Hoffa Jr. and his allies to bring about a restoration of the ancien regime, or at least the restoration of a few of its aspects.

You could wonder why Hoffa Jr. would have had any chance at all against Carey and his allies, given the reformer’s success at getting rid of some of the old gangsters, and the wonderful victory over UPS. But the old Hoffa regime had sunk deep roots in the Teamsters, and in union locals all over the country, minikingpins and satraps were still in office, and they feared Carey and his reformers.

So the old-timers organized a campaign for Hoffa Jr., and did it with a lot of zeal, too. And Carey, in order to retain the presidency and preserve the reforms, suddenly needed to raise a lot more money than anyone had imagined, when he first came to power.

Thus the ridiculous and shady fundraising scheme of 1996. Student militants from the early ’70s had gone directly into union reform campaigns. But there were other students from that time, members of Students for a Democratic Society, who had gone about building social-change institutions of their own, such as Citizen Action. Those people, the ones with institutions at their disposal, seem to have come up with the idea of receiving donations from the Teamsters’ union, which they could turn around and donate, through still other people, to the Carey reelection campaign.

It was a scheme to take union money, which ought not to have been put to factional purposes, and spend it on the factional purpose of getting Carey reelected.

The scheme was illegal. It was idiotic. It was self-destructive. It led to a judicial order prohibiting Carey from running for reelection, which, in turn, led to the victory of Hoffa Jr. in 1998. The scheme has now led to Carey’s indictment, given that, when he was asked about the fundraising shenanigans, he did the natural thing and denied knowing anything about anything.

The scheme made Carey and his allies look no better than any other corrupt union officials. The scheme was bad, bad, bad. And yet it ought to be pointed out that, in spite of appearances, Carey and his allies back in 1996 were not, in fact, corrupt union officials — not in the classic sense of that term anyway. For what was Carey’s motivation, and Trumka’s, and the other people active in the Carey reelection campaign?

Those people were not trying to get rich, nor to bring the Mafia kingpins back into power. They were trying to prevent the bad old days from returning. They had spent their lives fighting for the simplest honesty in some of America’s largest and more powerful institutions, and their fight had been successful, until that moment, and, in their panic, they were doing all too much to preserve what they had won.

After they were caught, a weird unholy alliance of critics stood up to point fingers at them — frustrated Cold War ideologues of the labor movement, from the long-gone era of Lane Kirkland; federal judges and prosecutors; nostalgics of Mafia power; and the champions of Jimmy Hoffa. Republicans pounded the table, demanding legal action against Carey. And now they have got what they demanded, and Carey faces trial, with a possibility of jail.

The Ron Carey affair, as it has played out over the last four years, has made the unions seem as corrupt as in the past. But the unions are not as corrupt. Even the new Hoffa regime in the Teamsters has had to mind its p’s and q’s, so far, due to the legacy of reform. There is more citizenly liveliness in the AFL-CIO today than at any time in recent memory. It is because of people like Carey and Trumka and their allies.

You might have thought that Carey would have won a little gratitude from the public for the role he has played, and the gratitude would tell in his favor now. But no, here he is at age 64, facing the worst. The man is (mostly) a hero, and is being treated like a criminal. The injustice ought to be obvious.

Paul Berman is the author of "A Tale of Two Utopias: The Political Journey of the Generation of 1968.

Whitman’s lesson for Romney

Layoffs at Hewlett-Packard show why business leaders aren't automatically a good fit for the White House

Mitt Romney and Meg Whitman (Credit: AP/Chris Carlson)

When Meg Whitman ran for governor of California in 2010, the former eBay CEO told voters that her business background made her the right choice to boost job creation in a state troubled by high unemployment. Sound familiar? It’s the same spiel we hear from Mitt Romney every single day.

As a consolation prize for getting clobbered by Jerry Brown in the gubernatorial election, Whitman landed a plum job of her own — CEO of Hewlett-Packard, a company that, like California, has been going through some tough times. But this week Whitman made clear that as a business leader, her approach to job creation doesn’t quite mesh with her political promises. Multiple media outlets are reporting that HP is planning to cut its workforce by around 30,000 jobs — a number that accounts for 7-8 percent of HP’s total workforce.

Whitman’s decision will probably result in some layoffs in California, but it wouldn’t be fair to label her an outright hypocrite on the basis of this strategy alone. Downsizing may well be the right course for Hewlett-Packard, which is having a hard time adjusting to an era where computing is moving to the smartphone and leaving the PC far behind. But there’s a data point in the New York Times’ report on the layoffs that deserves close attention: “China, which is one of H.P.’s highest growth areas, will probably be spared.”

Again, this makes strict bottom-line sense. Hewlett Packard, by its own admission, now derives around 60 percent of its revenues from overseas. China is the world’s fastest-growing market for computer gizmos. Cutting staff in China would be suicidal. And HP’s behavior is in no way extraordinary. In April, the Wall Street Journal reported that between 2009 and 2011, fully three-quarters of the new jobs created at the 35 largest U.S. multinationals were overseas. And this isn’t just about offshoring to cheaper labor. Overseas is where the demand is.

The job creation plan outlined by Whitman when she ran for governor included cutting red tape, lowering various government fees, and tax breaks. Again, it’s an agenda that maps quite closely to Romney’s — and that’s no accident: Whitman was Romney’s finance chair during his 2008 campaign, and hosted a California fundraiser for him in March. But while cutting regulations may boost corporate profits,  it doesn’t do a darn thing for boosting demand. HP is probably more likely to take the money saved via a tax break and spend it on a new R&D center in Shanghai than it is to staff up in Silicon Valley.

All of this explains why having an illustrious business resume doesn’t mean that one is automatically qualified to occupy the White House in a time of economic stress. Business executives have a mandate to act in their own self-interest — to seek profit by any means, including  downsizing in the U.S. and pouring resources into China. That’s why HP’s “Government Affairs” page stresses its support for ” free trade and the reduction of barriers across borders,” even in the face of growing evidence that outsourcing to China has a negative impact on U.S. job creation.

A political leader is supposed to think in terms of the larger public interest — which means things like figuring out how to fund education or pay for the social welfare net that protects the unemployed and feeds the hungry. California’s voters figured that out when they rejected Whitman. Once again, it will be interesting to see where the general public at large comes down in the case of Romney.

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Andrew Leonard

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

David Brooks, “structuralist”

The New York Times moderate says the welfare state is unsustainable, and buys himself a new $4 million home

David Brooks is everything that’s wrong with elite opinion in America. The president reads him and takes him seriously. That is why the opinions of venal faux “reasonable” clowns like Brooks matter. Brooks today sums up the new argument for not actually doing anything to alleviate worldwide unnecessary hardship: The problem is “structural,” not “cyclical”!

Long Op-Ed short, Brooks says “cyclicalists” (unnamed) think we should deficit-spend our way to prosperity, because, according to Brooks, they believe that “the level of government spending is the main factor in determining how fast an economy grows.” (No one actually believes this.) But according to Brooks, all of our problems are “structural,” which is to say that the reason we have mass unemployment and debt and growing wealth disparity is because of “technological change” and crappy schools. And “special-interest deals” in the tax code.

The point of the Brooks argument is simply to make continued non-action to address actual short-term pressing problems sound serious and wise. He’s not even making a partisan argument, you see. Oh, people on “the left” have been having their silly little debate, but all the serious people — “some on the left but mostly in the center and on the right” — have accepted the sad truth, like Brooks. And Brooks is soberly explaining the situation. He is not at all responding to Paul Krugman, his fellow New York Times columnist, who has lately taken to fiercely rebutting arguments put forth by various unnamed “centrists” and “moderates” in his columns.

This is Brooks’ conclusion:

But you can only mask structural problems for so long. The whole thing has gone kablooey. The current model, in which we try to compensate for structural economic weakness with tax cuts and an unsustainable welfare state, simply cannot last. The old model is broken. The jig is up.

It’s so sad, but everyone will now just have to accept that social democracy is an impossibility. We have learned that “the old economic and welfare state model is unsustainable,” so shut up about your unemployment benefits running out and there being no jobs still. (Silly me, here I was thinking the recent massive international financial crisis actually exposed post-industrial capitalism as the “unsustainable” thing.)

Ezra Klein has the rather polite, policy-based response to Brooks’ argument: Essentially that even if Brooks is right about America’s structural problems needing to be addressed, we should still also give poor people money and indebted people relief and spend money on infrastructure improvements to prevent these structural problems from becoming even worse.

Dean Baker has the response in which it is pointed out that Brooks is full of predictable, repetitive shit. The “we have no jobs because of technology and also there are plenty of jobs but unemployed people have the wrong skills” line is as old as the Great Depression and there is no actual evidence for it. It’s just what people who want to sound serious while dismissing efforts to spend money on economic stimulus say.

Hey, let’s check out some recent real estate news at the Washington Post’s Reliable Source blog, for fun. Looks like a Mr. David Brooks just bought himself a $3.95 million home in Cleveland Park!

The New York Times op-ed columnist and wife Sarah are trading up — from their longtime home near Bethesda’s Burning Tree Club to a century-old (exquisitely renovated) five bedroom, four-and-a-half bath house in Cleveland Park. It includes a two-car garage, iron and stone fence, generous-sized porch and balcony, and what appear to be vast spaces for entertaining. The timing seems to have been right: After only a few days on the market, their old place (which also boasts five bedrooms) is under contract for $1.6 million.

Whoops, sorry about your welfare state collapsing, 12 million out of work Americans, but it was just too “unsustainable” to keep you employed — you should all consider developing new skills and trying to find more “productive” work, like writing bullshit columns for the New York Times, maybe.

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Alex Pareene

Alex Pareene writes about politics for Salon and is the author of "The Rude Guide to Mitt." Email him at apareene@salon.com and follow him on Twitter @pareene

Bush vs. Obama: Jobs

During George W.'s first term, big government boosted employment. For Obama, it's the opposite

George W. Bush and Barack Obama(Credit: Reuters/AP)

There is a number buried in today’s government labor report that deserves closer examination: 35,000. That’s the net number of private sector jobs created during the Obama administration to date. That’s right, it’s a positive number. After the worst economic disaster to befall the United States in 80 years, that’s a number that maybe we should be applauding. Remember: The private sector hemorrhaged more than 2 million jobs in the first three months of 2009 alone. The hole was deep.

Unfortunately, it’s still a tiny number, and it is dwarfed by a much larger figure: 607,000. That’s the number of public sector jobs — federal, state and local — that have been lost since Obama took office. It’s a story that probably isn’t getting told enough about the Obama administration: Big government keeps getting smaller.

But the real eye-opener comes when we compare Obama’s numbers to George W. Bush’s. In Bush’s first term, the economy shed 913,000 private sector jobs! 913,000! The only thing that saved Bush’s first term from being a complete economic disaster, in terms of employment, was robust public sector growth: The economy added 900,000 government jobs. One wonders: Without the massive growth in the public sector during Bush’s first term, would he have been reelected?

This is interesting for a number of reasons. First, it punches a big hole in the theory that Bush’s tax cuts were responsible for boosting employment during his first term. Let’s also recall that the Bush recession (which he inherited from Clinton) was far, far milder than the near-Depression Obama inherited from Bush. In that context, Obama’s performance resuscitating the private sector has been miraculous. The Washington Post published an article criticizing Obama for not doing enough to resist job losses in the public sector, without fully acknowledging the political impossibility of additional stimulus after the first round, but we haven’t heard all that much over the years about how the growth of government saved Bush’s bacon.

Of course, Obama isn’t running against Bush, so that’s moot. But as this presidential campaign heats up, it might be worth periodically reminding ourselves: Bush led the U.S. economy out of a weak recession with strong public sector growth. Obama is leading the U.S. economy out of a near-death experience while a steadily shrinking government swells the unemployment rolls. Which magic trick do you think is harder?

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Andrew Leonard

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

Another jobs report downer

The U.S. economy underperforms again in April, creating only 115,000 jobs. You can almost hear Mitt Romney cackle

Job seekers wait in line during a job fair in Portland, Ore., on April 24. (Credit: AP/Rick Bowmer)

The U.S. economy is stuck in spring mud. For the second month in a row, the United States labor market underperformed expectations. According to the Bureau of Labor Statistics, the economy created a lackluster 115,000 jobs in April. The unemployment rate fell one notch, to 8.1 percent, but for a distressing reason: The overall size of the U.S. labor force dropped by 342,000, a sign that hundreds of thousands of Americans simply gave up looking for work in April. The labor force participation rate fell to 63.6 percent, the lowest mark since 1981.

The only good news in the report: The numbers for February and March were both revised upward, from 240,000 to 259,000 in February, and from 120,000 to 154,000 in March. The economy is still growing.  Indeed, over the past 12 months, the U.S has added 1.8 million private sector jobs.

The glum report comes as little surprise. While economic data points were all over the map in April, some key indicators — jobless claims, Wednesday’s ADP private sector labor report, and the first estimate of GDP growth for the first quarter of 2012 — all suggested that the economic recovery that seemed so robust over the winter was losing steam. The numbers aren’t bad enough to justify outright panic; Americans are still lustily buying cars, the manufacturing sector appears strong, and gas prices are dropping steadily for their recent highs  – but it’s still very difficult to see signs of sustained momentum. This is the economy we’ve got right now. We can’t even blame austerity: Government payrolls dropped by only 15,000.

Ironically, on Thursday, Gallup’s presidential approval survey showed Obama at 51 percent, the highest mark he’s received since Seal Team Six took out Osama bin Laden. Conventional wisdom has assumed that Obama’s steadily improving approval ratings tracked the growing economy. If so, it will be interesting to see if those numbers start coming down again.

Mitt Romney, as one might expect, is already on the case. He promptly told Fox News that it was a “terrible job report.” That, strictly speaking, is not true. A “terrible” jobs report is one in which the economy loses half a million jobs or more in a single month — as was the case when Obama took office in 2009. (In fact, economist Justin Wolfers tweeted, April’s jobs report marks a milestone of sorts: Private sector job creation is, for the first time, in positive territory for the entirety of Obama’s term. Since January 2009, the private sector has added 35,000 jobs. The public sector, in contrast, has shed 607,000. So much for Big Government!)

April’s jobs report is disappointing, and could signal worse news to come, but there’s still a decent chance that we are just experiencing a bump in the road. By most measures, the U.S. economy is performing much better than it was a year ago.

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Andrew Leonard

Andrew Leonard is a staff writer at Salon. On Twitter, @koxinga21.

Healthcare’s foreign invasion

Obama risked a trade war with China about manufacturing -- so why isn't he outraged about medical jobs?

(Credit: gualtiero boffi via Shutterstock/Salon)
This article was adapted from the new book, "Insourced", available May 8 from Dartmouth College Press.

Approximately 15 percent of all healthcare workers and 25 percent of all physicians in the United States were born and educated elsewhere. This means that 1.5 million healthcare jobs are “insourced,” occupied by foreign-born, foreign-trained workers brought into the United States on special visas earmarked for healthcare jobs. This number is 50 percent greater than the total number of jobs in the U.S. auto-manufacturing industry. It’s amazing to consider that in 2008 and 2009, the auto industry, which makes up just 3.6 percent of the U.S. economy, received a $97 billion bailout. If we estimate that each of these 1.5 million insourced healthcare jobs has an average wage of $60,000, that’s $90 billion a year in wages going to people brought into the United States to work rather than training Americans to do the same jobs.

The healthcare industry makes up 16 percent of our economy. Yet even in these days of close to 10 percent unemployment, we do not invest enough money in our young people to train them for jobs in healthcare — an already understaffed industry that will have to serve an additional 32 million people once the provisions of the 2010 health-reform law take full effect. Instead, when faced with pressure from hospitals and nursing homes for more healthcare workers, the federal government grants visas to import nurses, physicians, pharmacists, physical therapists, and many other types of healthcare workers from countries that can ill afford to lose them.

In some U.S. industries, the outcome of globalization is positive or neutral. Take the sugar industry. Due to lower labor and land costs and better weather conditions, it’s far cheaper to grow sugar cane in the Caribbean than sugar beets in North Dakota. As import taxes fall, global transportation improves, and the number of sugar beet farms in the United States declines, more Americans are sweetening their cereal with sugar from Jamaican sugar cane. Americans save money buying cheaper sugar; the economy of the poorer sugar-growing countries improves, lifting thousands of people out of poverty; and the few displaced American sugar beet farmers generally find other work. But sugar is not a strategic commodity. If CARICOM, the Caribbean Community, were to halt sugar exports to the United States, we would experience no crisis. Sugar is not essential to our diet or life, and we have plenty of substitutes, from honey and corn syrup to NutraSweet. If necessary, within a year we could again be producing sugar in the United States.

The U.S. healthcare industry is 200 times larger than the U.S. tire-manufacturing industry, yet President Obama risked a trade war with China, our biggest trade partner, over tires. He was understandably trying to protect well-paying manufacturing jobs for American workers. Yet each year, we bring thousands of nurses from China to work in even better-paying jobs rather than train young people in this country to become nurses. The irony is that the economic costs of “insourcing” healthcare workers, including the loss of jobs no longer available to Americans, are far greater than the costs when we import Chinese tires. In 2003 the Commission on Graduates of Foreign Nursing Schools (CGFNS), a U.S.-based nongovernmental organization that administers the U.S. nursing licensing exam for foreign-trained nurses, opened a testing center in Beijing. The opening of this center initiated a “mushrooming” of new nursing schools in China and led to credible predictions that China will soon surpass the Philippines as the number one source of foreign-trained nurses imported to the United States.

Given the publicity and furor over the loss of manufacturing jobs, the lack of protest over healthcare-worker insourcing is surprising. Congress passed legislation and President George W. Bush signed a law in 2007 to protect the American sock industry from the rival Honduran sock industry. Yes, that’s right: socks. Protecting a few hundred $15-an-hour sock-manufacturing jobs based solely in the small town of Fort Payne, Ala., was worth acting on. Yet insourcing hundreds of thousands of $60-an-hour healthcare jobs has prompted no such similarly high-level response from our leaders.

Instead, on a regular basis, Congress approves and presidents from both political parties sign legislation to enable the legal entry of an ever-increasing number of foreign healthcare workers. Each year, about 20,000 new healthcare-specific visas are issued for these workers.

The United States has traditionally not allowed strategic industries to be outsourced. That’s why the U.S. steel industry and the U.S. car industry have received bailout after bailout. Access to enough steel and automobiles is essential to our economy; without a sufficient supply of each, our economy would be severely damaged. It’s time we acknowledged that the health of the population is just as important as steel and autos in keeping our economy strong. Healthcare is too important to risk continuing to insource it.

It’s not just a matter of protecting and expanding jobs for American workers. Every year, thousands of Americans die, and the health of thousands more is compromised, because of the shortage of healthcare workers in every one of the healthcare professions.

On the surface, insourcing may appear to be a harmless or even win-win solution to the country’s healthcare-worker shortage. The hospital receives a much-needed worker, and the worker escapes life in a struggling country for a better life here. But we should be training more people in this country to work in those professions, especially people from poor and minority communities. Rather than investing in our own people and communities, however, the U.S. government has decided to take the best and brightest workers from struggling countries.

Many foreign-trained healthcare workers, no matter how smart, are not adequately prepared for practice in the fast-paced, high-tech world of U.S. medicine. Whether in operating rooms, hospital wards, or nursing homes, inadequately qualified and poorly oriented foreign healthcare workers endanger the lives of their patients, as well as the lives and careers of their American-trained colleagues.

But the main reason for this country’s rise in unnecessary deaths and delayed care is understaffing — a result of the failure to train and place enough healthcare workers, especially in rural and underserved communities. Americans who live in rural areas make fewer visits to healthcare providers and are less likely to receive preventive care. The infant-mortality rate for African-Americans is twice that for the average American; Latinos are twice as likely as white Americans to die from diabetes. These health disparities are due in large part to a lack of healthcare workers, especially primary-care workers, in their communities. The quick fix has been importing foreign healthcare workers for these unfilled positions. Unfortunately, once these workers fulfill their initial contracts, most move to communities without healthcare-worker shortages; in fact, foreign-trained healthcare workers are more likely to practice in the well-served, major metropolitan areas than their American-trained counterparts.

Even if good foreign-trained healthcare workers were here in numbers adequate to meet our needs, the U.S. healthcare system is about encounter a tidal wave of demand as 78 million baby boomers approach their 60s. Older people make, on average, six visits to a healthcare provider a year, compared with two visits per year for people under 60. The healthcare workforce is aging, too: More than 50 percent of practicing healthcare workers are eligible to retire during the next 10 years, which will leave us with fewer workers to treat more and sicker patients.

In the eyes of employers, of course, insourcing healthcare workers appears to offer many benefits. Most doctors and nurses in developing countries earn a fraction of what American doctors and nurses earn: A Caribbean nurse makes around $1,000 a month; an Ethiopian physician, about $100 a month. Not only are many foreign-trained healthcare workers accustomed to lower salaries and quality of life, but they also carry little or no education debt, while their American-trained colleagues typically graduate with five- and six-figure debt burdens. With average student debt burdens of $155,00011 for newly graduated physicians and $30,375 for nurses, American-trained health workers require a higher salary just to help pay for their education. Trained in a much more hierarchical environment, foreign workers are much less likely to unionize, or even express dissatisfaction with their work. As the percentage of imported healthcare workers increases, their attitudes toward salary and terms of employment undermine the bargaining power of U.S. workers, and even affect the important feedback loop between employees and management.

Polls indicate that 70 to 80 percent of Americans want to reduce the rate of immigration into the United States. Yet the American public is not aware of our policy of using healthcare-worker-specific visas to solve the healthcare-worker shortage.

Some legislators who publicly support stabilizing immigration consistently vote to increase the number of healthcare-worker-specific visas granted each year. It’s not that American citizens don’t want to become healthcare workers and fill these jobs. This distinction is critical, because every industry that has brought in foreign workers has argued that American workers won’t do the work for the prevailing wage, or won’t do the work no matter how high the pay is. In the healthcare industry, this argument does not apply. U.S. citizens want the jobs. They just can’t access the training. The United States does not have enough positions in health-professional schools to meet industry demands.

The tens of thousands of qualified nursing school and medical school applicants who are denied entry to school each year permanently lose out on their chosen careers, work that is consistently ranked in the top tier of salaries, with excellent benefits and almost guaranteed job security. This loss of career opportunity is even greater for rural and minority young people, who are grossly underrepresented in the higher-level health professions, such as physicians and nurses, and overrepresented in the lower-level professions, such as technicians and home health assistants. Something is wrong when so many young Americans are forced to pursue other, lower-paying careers at a time when we desperately need more healthcare providers. In exchange we get foreign healthcare workers who are less well trained (they consistently score lower on licensing exams than U.S.-trained healthcare workers) and far less culturally competent than native-born Americans.

The most tragic and most preventable effect of our hiring so many healthcare workers from other countries is the unnecessary deaths of hundreds of thousands of men, women and children in developing countries. The World Health Organization (WHO) estimates that each year more than 10 million people die needlessly, from easily treatable maladies such as diarrhea, pneumonia, malaria, tuberculosis, vaccine-preventable diseases, and complications of childbirth. The WHO Global Health Workforce Alliance estimates that there are a billion people alive today who will never see a health worker in their lives. In Ethiopia, one in 10 Ethiopian children will die before his or her fifth birthday — yet there are more Ethiopian physicians in the Chicago area than in all of Ethiopia, which, with 80 million people, is the second most populous country in Africa. As their most skilled nurses emigrate to work in U.S. nursing homes, middle-income countries such as Jamaica and Trinidad have nurse-vacancy rates of 60 percent or higher.

Throughout the developing world, nurses, pharmacists, physical therapists, and many other types of healthcare workers are being approached and offered 10 times their salaries to practice in modern U.S. healthcare facilities with state-of-the-art technologies. Even the most dedicated, socially conscious worker would be tempted by such an offer. A colleague of mine relayed a conversation he’d had with the head of the Nursing Council of Kenya, who told him about the damage the exodus of senior nurses was doing to her country’s healthcare system. In the next breath, she confessed that the next time he visited Kenya, she might not be there. She was thinking about emigrating herself.

Our unofficial policy of relying on the world’s poorest countries to pay for the training of workers whom we then entice and bring to this country is devastating healthcare systems around the world. The loss to a developing country when a single physician, representing what may be a significant portion of their total number of physicians, emigrates is far greater than our gain. Our failure to provide education for our own citizens and to better plan for healthcare staffing and distribution does not justify poaching nurses and physicians from the countries that can least afford to lose them. How many additional deaths, how much more needless disability and suffering, will we allow this misguided policy to cause?

And consider American competitiveness. Certain industries are vital to U.S. global leadership. Recognizing their importance, we protect those industries. We don’t allow them to move overseas and make the United States vulnerable to the actions of other countries. Poor farmers in the developing world can certainly grow food staples more cheaply than American farmers do. But because of the strategic importance of the U.S. food supply, we subsidize some basic food crops, such as corn and soybeans.

And yet we are overreliant on foreign healthcare workers to meet our most basic health needs. This is particularly dangerous because many countries, almost completely drained of healthcare workers and tired of subsidizing the U.S. healthcare system, are trying to slam the door shut for emigrating healthcare workers. Meantime, of the world’s wealthiest nations, the United States has the worst health outcomes, with lower life expectancies and higher rates of deaths from preventable causes. In infant mortality, for instance, we rank 27th, behind Poland and Hungary. Our disability levels are higher than in most former Soviet countries.

If the United States is to remain competitive in the global economy, we need a healthy workforce. In order to achieve that, we need a healthcare workforce made up of adequate numbers of properly trained physicians, nurses, pharmacists, community-health workers, and other healthcare providers.

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Dr. Kate Tulenko is a physician with degrees from Harvard University, Cambridge University and the Johns Hopkins School of Medicine. The former coordinator of the World Bank's Africa Health Workforce Program, she currently serves as director of clinical services for a global health nonprofit.

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