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Immigration: The Other Health Care Crisis

Prepared by: Toni Johnson
July 9, 2007

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The defeat of the Senate’s beleaguered immigration bill (FT), which included a so-called amnesty policy backed by Democrats and the Bush administration, marked “a huge victory” (WashTimes) for congressional conservatives. But the issue opened a “deep fissure” (BosGlobe) within the GOP, pitting business interests against rule-of-law conservatives. Democratic candidates went on the attack (Orlando Sentinel) soon after the bill’s demise, calling for “their Republican rivals to drop divisive demands” and reiterating their commitment to reforming immigration policy. Meanwhile, Economist.com suggests that the Bush administration and congressional Democrats “misread the depth of hostility to the reform” and predicts any future overhaul effort will likely meet a similar fate.

For all the high-profile debate on immigration, little attention has been given to the intersection of immigration and health care (MarketWatch). Roughly twelve thousand to fifteen thousand nurses a year are currently admitted via the U.S. visa system to help alleviate shortages. The American Hospital Association warns recruitment of qualified nurses is already limited and the Senate bill would have further taxed efforts by giving more weight to applicants with advanced professional degrees. Others criticized the legislation’s provision to drop nurse screening, raising concerns that some migrant nurses lack the training (Business Journal of Phoenix) of their American counterparts. Estimates indicate the United States, which has stepped up its foreign recruitment (AP), will be short 1 million nurses by 2010. Some experts express doubts over whether there is a U.S. physician shortage, but the American Medical Association now concedes that such a shortage exists. One study estimates the United States will be down two hundred thousand physicians by 2020. A 2004 report (PDF) by an immigration advocacy group examines the role foreign-born workers play in delivering health care in the United States.

U.S. shortages are part of a worldwide trend in health worker numbers. The World Health Organization (WHO) in a 2006 report identified a shortage of 4.3 million health workers globally. CFR’s Laurie Garrett notes that international health efforts in developing nations “suffer from the enormous global deficit in skilled healthcare workers.” While both developed and developing nations face shortages, the WHO says the greatest shortages are felt in countries with the biggest health care burdens. Africa is hardest hit (New England Journal of Medicine), bearing 24 percent of the global burden of disease but containing only 3 percent of the health care workforce.

The migration of health care workers from developing countries to the rich world exacerbates this problem (CNN). The WHO says industrialized countries should reduce “dependency on migrant health workers.” Michael Clemens at the Center for Global Development disagrees with the WHO’s “ethical recruitment” push, calling it a “euphemism” for denying African women the right to better their lives. Some countries, such as the Philippines and India, are training a large number of nurses specifically for the purpose of exporting them.

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