Unemployment

Unhappy meals

"Fast Food Nation," a stomach-churning critique of the health and labor practices of the burger business, argues that Americans should change their dietary habits. Good luck.

Americans spend more money on fast food than on higher education, personal computers, computer software or new cars. Every month more than 90 percent of American children eat at McDonald’s; the average American eats three hamburgers and four orders of french fries every week.

What’s in all those hamburgers? They’re most likely made from the meat of worn-out dairy cows (generally the least healthy cattle stock), which spend their days packed in feedlots full of pools of manure. Each burger contains parts of dozens or even hundreds of cows, increasing the likelihood that a sick one will spread its pathogens widely.

Until 1997, those cows, by nature designed to be herbivorous, were fed “livestock waste” — rendered remains of dead sheep and cattle, along with the remains of millions of dead cats and dogs purchased every year from animal shelters. Thank God the law was changed: Now they’re fed only the remains of horses, pigs and poultry. And if you think your fries are animal-free, guess again. While McDonald’s no longer cooks them in beef tallow, a process that until 1990 gave the chain’s french fries more saturated fat per ounce than its burgers, McDonald’s still acknowledges that some of the flavor comes from “animal products.”

Eric Schlosser, author of “Fast Food Nation,” is troubled by our nation’s fast-food habit, but what goes into the burgers and fries isn’t even half the problem, he says. He admits that most of the fast food he ate while he wrote the book “tasted pretty good.” (It should, he notes — fast-food restaurants rely heavily on the services of the billion-dollar flavor industry, which manufactures and sells the complex chemicals that give distinctive flavors to processed foods such as “smoky” chicken, “strawberry” shakes and even “flame-broiled” burgers.)

The reasons Schlosser sees fast food as a national scourge have more to do with the sheer ubiquity of the stuff — the way it has infiltrated almost every aspect of our culture, transforming “not only the American diet, but also our landscape, economy, workforce, and popular culture.” An estimated one out of every eight workers has at some point been employed by McDonald’s, and the nation’s 3.5 million fast-food workers are the largest group of minimum-wage earners.

What’s more, the values the fast-food industry spreads embody capitalism at its worst: hostility to workers’ rights, along with a dehumanizing emphasis on mass production and uniformity at the expense of meaningful worker training and autonomy. At the same time that they invest large sums to design equipment so streamlined that it requires as little skill as possible to operate, fast-food companies accept hundreds of millions of dollars in government subsidies for “training” their workers, through programs intended to reward companies that teach job skills to the poor.

Schlosser also details the fast-food industry’s efforts to market directly to kids. He’s especially interested in the unholy alliance between McDonald’s and Disney, two corporations united not just in their hostility to unions and their quasi-feudal style of dealing with their workers but also in their determination to infiltrate the imaginations of toddlers. Of the two, McDonald’s has been the more successful: Ninety-six percent of American children recognize Ronald McDonald. Only Santa Claus rates higher.

In perhaps the most disturbing section of “Fast Food Nation,” Schlosser reports on the rise in Colorado of corporate “sponsorships” to cover shortfalls in school districts’ budgets: “Whether it’s first graders learning to read or teenagers shopping for their first car, we can guarantee an introduction of your product and your company to these students in the traditional setting of the classroom,” reads one chilling brochure for a Kids Power Marketing Conference. Fast-food companies are at the leading edge of this new marketing strategy, placing not just hallway ads and banners in schools but also targeted, branded educational materials in classrooms, produced with tax-deductible dollars.

With its far-reaching analysis of a low-grade sickness nibbling at the very entrails of America, “Fast Food Nation” is a jeremiad, but Schlosser never comes off as a “sky is falling” street-corner raver or bullheaded finger-pointer. His fury is evident, but his voice is measured and his methods are subtle. He eschews alarmist adjectives, preferring instead to let his artfully assembled mountain of statistics and damning quotations make its own case. He’s obviously arguing from the left and yet he never oozes ideology; he criticizes corporate domination of the cattle industry, for example, by painting portraits of independent ranchers who have been run out of business. “The ranchers most likely to be in financial trouble today,” he writes, “are those who live the life and embody the values supposedly at the heart of the American West. They are independent and self-sufficient, cherish their freedom, and believe in hard work — and are now paying the price.”

Schlosser isn’t opposed to the concept of fast food per se. He includes examples of fast-food pioneers who marched to their own individualist beat, such as Carl Karcher, the founder of the Carl’s Jr. chain. Karcher is no Alice Waters, but his example shows the value of stubborn hard work and honest business practices. Karcher’s blindness to the downside of the fast-food revolution in which he played a part seems to come more from a sort of tone-deafness than from greed.

Even in the book’s gross-out section on food safety, Schlosser concedes that, so far, the slaughterhouse conditions he documents present no widespread health threat. And the book ends with what can only be called a tribute to In N Out Burger of California, a family-owned chain that has refused to franchise and pays the highest wages in the fast-food industry. In N Out peels its own potatoes and uses fresh beef, and it does without microwaves, heat lamps and freezers. It’s ranked first in the nation in food quality, service and atmosphere, and the most expensive thing on the menu costs $2.45.

So what can be done to break the grip that the rest of the fast-food industry has on us? In a brief section titled “What to Do,” Schlosser sketches possible remedies. He wants to see some action by government, including a single food safety agency, higher standards for food safety in school cafeterias and a ban on advertising “unhealthy foods to children,” which might then cause McDonald’s, for example, to lower the fat content of its Happy Meals, and thus make a dent down the road in the trend toward obesity. He also suggests eliminating job-training subsidies for fast-food chains that churn through workers and don’t actually help them acquire any skills, as well as “passing new laws to faciliate union organizing” at these chains, which he admits might not lead to widespread unionizing but would encourage the industry to treat workers better.

His final appeal to end the fast-food industry’s bid for domination, however, is aimed not at government but at consumers: “Turn and walk out the door,” he encourages, the next time you’re about to buy fast food.

As a reader — and an eater — I’m Schlosser’s perfect audience. I consume my share of hamburgers, but rarely at a fast-food chain, unless I’m starving and trapped on Interstate 95. I’m probably as turned off by the nutritional vacuum fast food represents as I am by the specter of automaton minimum-wage staffers reciting their “Would you like to supersize that?” scripts. So why did I get a sinking feeling as this altogether reasonable, well-researched and heartfelt book ended? Why do I doubt that Schlosser will end up changing many minds not already sympathetic to his point, let alone alter much behavior? I think the main problem is Schlosser’s appeal to cold, hard reason rather than enlightened appetite.

He’s right that it’s important to try to change public opinion about acceptable corporate behavior, especially when corporations are using shady practices to control an activity as intimate and as central to our overall well-being as eating. But Schlosser has left out a discussion of what needs to replace all those fast-food meals — the kinds of fresh foods that would be affordable, accessible and familiar enough to override Americans’ daily cravings for fries, burgers and other processed, taste-engineered foods. And he doesn’t even approach the question of what it will take for a healthier and more varied way of eating to win over the low-income people who are the captive market for fast food right now.

The improvement of the American diet in this age of rampant obesity is a complicated socioeconomic problem, but it’s partly a question of changing tastes, of educating palates — and making no apologies, regardless of the implied snobbery of the project. Surely, “Let them eat In N Out Double Doubles” can’t be the only answer. Schlosser has certainly made his case, and we’d be fools to ignore him. But in the end, I found myself wishing that “Fast Food Nation” had tried to appeal more to the stomach than to the brain.

Maria Russo has been a writer and editor at The Los Angeles Times, The New York Observer and Salon, and is a regular contributor to the New York Times Book Review.

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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