Unemployment

Got guilt?

Dairy workers grub for minimum wage in sickening manure pits -- so American consumers can have cheap milk and cheese.

  • more
    • All Share Services

Got guilt?

Lazing cows dot the rolling hills of the picturesque Willamette River valley, and the air smells sweet of grass and manure. But this sunny image masks a grim reality for dairy workers like Arturo Ramirez. For six years, Ramirez’s duties included maintaining a pump that sprayed liquid dung onto the fields as fertilizer. To get to the pump, he had to walk waist deep in manure across a pit as long as a swimming pool. Wading through manure isn’t like walking through water: The sludge is heavy, the rotten-egg smell of hydrogen sulfide rises off the slick surface, and if you’re unlucky, you can slip and drown.

Ramirez didn’t die in the manure pit — a fate met by three workers in California — but as he waded through the waste of 380 cows, it slid into his knee-high boots. Because it’s impossible to completely scrub away the bacteria from manure, Ramirez passed a skin infection on to his wife and her two daughters. “I felt like a slave; it was like my boss had a whip,” says Ramirez, 27, who relocated to this lush rural valley from the desert of central Mexico.

Arturo Ramirez is not his real name, and he has a new job at a different dairy, but he worries he’d be fired if his boss discovers he has talked to a reporter. Ramirez can’t afford to be out of work. When his father died 12 years ago, he crossed the border through the Arizona desert to find work to help support his mother and four younger brothers and sisters. Without the $400 he sends home every month, his family would barely survive.

It’s not an easy sacrifice: Ramirez works 12 to 16 hours a day, six days a week, for minimum wage and no overtime pay. Until this past February, when Oregon passed a new law, dairy workers were afforded no lunch or rest breaks. In more than 40 states no such law exists, leaving many employees no choice but to eat lunch while working. Ramirez, like other dairy workers, is regularly kicked by cows and is exposed to toxic gases in the manure, such as hydrogen sulfide, that may cause permanent neurological damage.

“I worry every day that I will break my hand or get hurt, but I never say anything for fear I’ll lose my job,” says Ramirez, who uses a fake Social Security number. “No American would do this job. This is a shit job, for shit money.” Yet Ramirez, like most other dairy workers, has few other employment options besides agriculture. Since the vast majority are non-English-speaking immigrants, and none are unionized, relatively few complain to state or federal agencies for fear of losing their jobs or being deported, according to legal aid organizations in Oregon and California and the United Farm Workers of America. Even if they were speaking up about working conditions, fighting for protection would still be an uphill battle.

The workers, who on average make between $5.15 and $7.06 per hour, can’t compete with the wealth and political power of their employers. In 2002 the dairy industry gave more than $5 million to state and federal campaigns. “Dairymen have a good ear when it comes to approaching the legislature,” says George Gilman, an Oregon state representative and recently retired dairy owner. “The industry is really well represented in legislators around the United States. There’s enough people that understand the challenges of our industry.”

The federal government collects no statistics about dairy workers, no advocacy groups work solely for dairy worker protection, and federal law has lagged as family farms have been consolidated into more-corporate enterprises. This failure to develop and enforce even the most rudimentary health and safety standards goes unnoticed because immigrant workers are among the most exploitable members of the workforce. “Despite the fact that the conditions amount to near slavery, dairy workers tend to get ignored,” says Brent Newell of the Center on Race, Poverty and the Environment, based in San Francisco. “This industry is extremely powerful.” And with consumers mostly concerned about the availability of cheap milk and cheese, there’s no public clamor for an improvement of the dairy workers’ labor conditions. Says Charlie Tebbutt of the Western Environmental Law Center: “Who’s going to fight milk? It feeds and nourishes babies; it’s Chevrolets and apple pies.”

Dairy work is a repetitive and debilitating dance. Hundreds of times a day dairy workers attach hoses from automated milkers to the teats of cows. They also lift hay bales, carry or shovel grain, and attach equipment to tractors. All these motions can cause chronic sprains, strains and lower back pain.

Over time, repetitive motion injuries can cause permanent, crippling damage. “While these men are young, if they continue this work for the next decade they can end up with lifelong pain and permanent disability,” says James Meyers, an agriculture and environmental health specialist at UC-Berkeley’s School of Public Health. “These types of injuries are very painful, very limiting and very expensive to treat. This side of fatalities, musculoskeletal disorders are the most debilitating occupational injury.”

Aside from chronic problems, dairy workers often break bones from being kicked by cows or from slipping in the muck-covered concrete floors of dairy barns, explaining why the rate of injury on dairy farms is higher than in all other types of agriculture and all private industry, according to a 2003 report in the Journal of Agricultural Safety and Health. Furthermore, dairy workers exposed to toxic-gas-releasing manure may experience nausea, diarrhea, sore throats, stress and alterations in mood, according to a 2000 study published in the Journal of Agromedicine.

Workers are not getting the treatment they need, says Tillamook County (Ore.) Health Department case manager Diane Barnes. Immigrant workers rarely file workmen’s compensation insurance claims for fear they will lose their jobs, Barnes says. Such insurance covers medical costs and wages lost due to injury-caused time off, but they also cost employers as much as $2,000 per worker. “The guys with documentation don’t work in the dairies, and there’s a huge fear of retribution because there are people just waiting to take their job,” says Barnes. “Whether spoken or unspoken there appears to be some kind of agreement that they aren’t going to make waves. Everyone seems to acknowledge that the employer has them there to make money, not cost money.”

Yet workmen’s compensation claims are one of the prime ways that the Oregon Occupational Safety and Health Administration, the state agency charged with protecting workers, prioritizes what companies to investigate. With only 75 field officers to regulate more than 80,000 employers in Oregon, a state more than twice as large as New England, the agency admits there’s no way it can be a watch-dog. Due to the dearth of worker’s comp claims, last year the agency investigated only 17 of the state’s 343 dairies. That figure earns Oregon a better than average grade: In 2003, state and federal agencies inspected 51 of the nation’s 86,300 dairy farms.

“There’s no way we can be everywhere at once. We want employers to be self-sufficient,” says Trudi Tyler, an Oregon OSHA compliance officer. “We’ve gone a long way to create an atmosphere to not create an adversarial position within the industry.”

Even when agents do conduct inspections, the regulations are marginal. Unlike the meat packing or construction industries, the dairy industry has no specific standards; nearly a century ago, Congress caved in to powerful Southern rural politicians and exempted agriculture from most worker-protection laws. As the farming industry has expanded into an industrialized enterprise, the laws haven’t changed. Today, dairy owners are held to the same weak regulations governing farms, with no specific guidelines for how workers should be specifically protected from milking machines or general interaction with cows. In the 24 states that defer to federal regulations, dairies with fewer than 10 employees are exempt from inspections unless an employee dies or at least three people are hospitalized.

Indeed, basic labor laws found in other industries don’t even apply to dairy industry workers. Like all other agricultural employees, dairy workers are excluded from the National Labor Relations Act. But because dairy work is year round, they are also omitted from the Migrant and Seasonal Agricultural Worker Protection Act. Protected by neither of those two laws, dairy workers are exempt from overtime pay and the right to form a union or to confront an employer with workplace concerns as a group, and they have no general safeguard against employer misrepresentation. This makes dairy workers the least protected laborers in the country, says attorney Mark Wilk of the nonprofit Oregon Law Center.

“Dairy folks are legally in the worst of all worlds. There really is no federal law at all to protect them,” Wilk says. Nearly one-third of his 89 clients are Hispanic dairy workers, and Wilk says their Mexican and Guatemalan origin is part of why the laws remain weak. “This is the last bastion of feudalism. The ugly reality of the world that my clients live in is shocking. We’re the richest country in the history of the world. We can do a better job making sure all workers have minimum standards of decency.”

Over the craggy Cascade Mountains, the arid plateau of eastern Oregon is a lonely landscape of sagebrush, power lines and ochre dust. Just south of the Columbia River, down a long narrow road, Threemile Canyon Farm stretches across 93,000 acres, housing 35,000 cows. This massive enterprise is one of the most extreme examples of the corporatization that has steadily been swallowing small dairies throughout the country. In just little over a decade, the number of dairies nationally has declined by half but the average size has increased by 73 percent.

A joint venture between R.D. Offutt, one of the largest potato growers in the country, based in Fargo, N.D., and John Bos Family Farms, a Bakersfield, Calif., dairy operation, Threemile Canyon Farm’s three dairies produce 1.3 million pounds of milk per day — enough to serve nearly the entire population of Idaho. Such size is a good business model: Threemile, which also grows potatoes and alfalfa and has a composting operation, generates an estimated $250 million for the local economy. Critics say the poor working conditions for the dairies’ 140 employees help spell this fat bottom line. In rural Boardman, about 20 miles from the dairy, a group of workers just finishing an 11-hour shift spill into Gerardo Castellano’s three-room apartment. As the smell of frying tortillas wafts from the kitchen and a young boy all belly and dark eyes runs through the room, the men fold their exhausted forms into sagging couches and explain in Spanish why they feel like second-class citizens.

They often work as many as 12 hours a day, six days a week, and are paid a weekly salary of $550. If there are 31 days in a month, they are not paid for the 31st day. While they would like a weekend, and more than one week off a year, they say if they miss a day, even for a family emergency or visit to the doctor, they will be fired. “We’re disposable to them. We’re like a machine. I don’t think they see us as real people,” says Julio Arturo Sepulveda. “I need this job. I feed my family with this job, but it’s not right.”

As the men joke and tease each other over who works the hardest, they all list the same woes: bruises from kicking cows, chronic coughs and asthma from the dust, achy joints, and lower back problems. Castellano, who once worked in an accounting office in Mexico, says, laughing, “Pick a place — it all hurts.”

Paradoxically, this trend toward corporatization may offer dairy workers a small slice of hope. No dairies in the country are unionized, largely because the majority of dairies are small, decentralized operations with only a handful of employees. Dairy workers at Threemile Canyon say that with numbers comes strength. In January 2003, a group of 100 dairy workers stormed the United Farm Workers local in southern Washington, outraged at sudden wage cuts, says Erik Nicholson, the union’s regional director. Since then, change has been tangible. Union organizers, effective at beating the drums, have spurred articles in the local and regional media, written letters to Oregon legislators and the Mexican consulate, and instigated an OSHA investigation, which resulted in 12 citations.

Subsequently, the dairy has increased wages by $200 a month, provided health insurance to its workers, and has started to provide the required safety equipment and training for the use of hazardous chemicals, Nicholson says. “These guys have come to experience firsthand the power of collective action,” says Nicholson, sitting on the tailgate of his truck, parked in Boardman. “Now they understand their rights and they’re overcoming their fear.”

Indeed the tone of the workers congregated at Castellano’s apartment is miles from the hopeless and anxious tenor of isolated workers in western Oregon. Rather, their voices are strong and determined. “I have faced a lot of discrimination because I’m a union supporter, but I want to stay and fight until they understand that we have rights,” Sepulveda says. He and 68 other workers recently settled claims against the dairy for failure to pay minimum wage. “I want the best for my kids, and so the abuses, the discrimination, it has to stop.” Still the process is slow. After over a year of repeated attempts at negotiation, the company still does not recognize the union. It has hired consultants and lobbied at the state Legislature for a bill that would outlaw harvest strikes and allow farm owners to negotiate union contracts for an unlimited amount of time. According to the company, its size makes it a union target.

“It’s economically efficient for them to try and unionize because we’re a large-scale enterprise,” says Len Bergstein, a spokesman for Threemile Canyon. The company has a letter signed by 100 dairy workers saying they don’t want a union. “This is no more than a series of attempts to ruin a business enterprise that workers depend on.” Industry insiders take a broader view, explaining that this fight is just part of the growing pains the entire industry has experienced over the past decade.

As Hispanic immigrants increasingly replace young family members or other local teenagers, dairy owners are working to meet the needs, such as insurance and benefits, of this new population of workers, says Agnes Schafer a vice president of the Dairy Farmers of America, based in Kansas City, Mo. “Throughout the U.S. we are going through an evolution of understanding,” says Schafer. “Farmers in general are pro-Hispanic because it’s economical and it’s people who want to work and who value agriculture, but we’re going through a cultural shift.”

While the industry is not working on any legislative efforts that would supply insurance or other services to undocumented workers, industry lobbyists say that President Bush’s proposal to grant some farmworkers citizenship would help. Yet in the short term there is little on the horizon that offers much solace for immigrant dairy workers.

Even if Threemile Canyon Farms is eventually unionized, the thousands like Ramirez who work in dairies with just a few employees will continue to work despite low pay and dismal conditions. “Back there [in Mexico], you work for $5 a day. All we had in my town was one donkey,” says Ramirez, shaking his head at the memory. “My mom misses me; she cries sometimes when we talk on the phone, but I can’t go back to Mexico. I’m afraid to die in the Arizona desert.”

Rebecca Clarren writes from Portland, Ore.

Whitman’s lesson for Romney

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

  • more
    • All Share Services

Whitman's lesson for RomneyMitt 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.

Continue Reading Close
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

  • more
    • All Share Services

David Brooks,

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.

Continue Reading Close
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

  • more
    • All Share Services

Bush vs. Obama: JobsGeorge 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?

Continue Reading Close
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

  • more
    • All Share Services

Another jobs report downerJob 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.

Continue Reading Close
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?

  • more
    • All Share Services

Healthcare's foreign invasion (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.

Continue Reading Close

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.

Page 1 of 77 in Unemployment