Brain Drain From Emigration of Medical Professionals May Be Imaginary

The UK at one time (and possibly still) had a policy not to recruit aspiring physicians from the developing world to the UK's medical schools. Policy-makers thought that to do so would be to take the best and brightest from abroad and (selfishly) build human capital in the UK, immorally exacerbating the brain drain from already struggling countries - the assumption being that the newly-minted physicians would not return home to contribute to building their economy with their new skills. Sometimes true, yes, but it's worth pointing out that Dennis Mukwege, 2018's Nobel Peace Prize recipient (who is Congolese) got his obstetrics training in France, and was recognized for his surgeries to repair or save women raped by combatants in Congo. It's a good thing France does not have such a policy, or those women would have been disabled or killed by their traumas.

It should also be mentioned that if YOU are an aspiring physician in a developing world country who wanted to pursue your career, and you have your sights set on a British medical school but you're rejected because you're from a developing country - this might not seem to be the most moral choice for the British policy-makers to have made.

So a recent study of emigration of skilled medical professionals (nurses) from the Philippines is a useful contribution to this discussion. To be clear, these are nurses trained in the Philippines who then leave the country to work in the USA - an even "worse" brain drain than what the UK policy aimed to prevent, because the human capital investment is made at home in this case, and then creates value abroad. Therefore, if it turns out there's no damage to the home country's economy, in this even WORSE case, there wouldn't be a problem with developing-world physicians getting trained in the UK. So what did they find?

"...we show that enrollment and graduation in nursing programs increased in response to demand from abroad for nurses. For each new nurse that moved abroad, approximately two more individuals with nursing degrees graduated. The supply of nursing programs increased to accommodate this. New nurses appear to have switched from other degree types. Nurse migration had no impact on either infant or maternal mortality."

This is damning for the UK's policy, because it strongly suggests that all they were doing was discriminating against the developing world's applicants, without paternalistically "protecting" the developing world's economy. Whether this new information affects the policy is another question - if appearing to your countrymen as if you care is more important than actually helping the people you say you care about, then nothing will change.

Original paper here - Abarcar P and Theoharides C., "The International Migration of Healthcare Professionals and the Supply of Educated Individuals Left Behind." H/T Marginal Revolution.

Post Election Priorities

It's been said that there is no liberal or conservative way to pave a road.  Political differences are usually differences of priority or method, rather than absolute ones.  The following are priorities for the U.S. and for California that it seems difficult to argue against.

NATIONAL

- We need a sustainable budget, independent of the current fiscal cliff situation, independent of how we get to that sustainable budget.  This is the single greatest threat to continued American prominence and liberal democracy on Earth.  It's a bridge too far to ask us to reform our tax system to incentivize wealth-building rather than wealth-hiding, and to reward tax-code-jockey attorneys, but we should start thinking about it.  Specifically, people regard taxes as penalties, period.  Start penalizing things you want people to do less of - polluting, crimes, unhealthy behaviors, etc.  (Singapore has used this model successfully for quite a while now, and we seem to think such "social engineering" is okay when it comes to owning homes and marriage.)  In other words, we should stop penalizign earning money and investing.

- Continue the economic and diplomatic pivot to Asia, and focus on containing the remaining threats to liberal democracy and the international order.  The countries which pose the greatest threat on that count, in this order, are Pakistan (which is largely run by extremist Muslims, and has nuclear weapons - how does this escape the notice of hawks?), Iran, and North Korea.  A nuclear weapon built in Pakistan and used by militants will be too late a reminder that the U.S. should not design its foreign policy around oil companies.

- Restructure immigration as recruiting.  Stop letting people in just because their husband is here; make it much easier to get people who have STEM degrees from top universities around the world, otherwise they will continue going to the UK and (increasingly) Asia.  At the same time, we can recognize that there's a legitimate security and economic consideration about the porousness of our border with Mexico that has nothing to do with racism, which unfortunately seems to be what has motivated the most passionate opinions on this issue.  After the election, the GOP has suddenly realized that not every American is a WASP and a reform of their immigration position is necessary.  Let's take advantage of this moment.

- The legalization of marijuana in Colorado and Washington is a more radical opportunity for local politics than many realize, because it will force a confrontation on state vs Federal rights on this and many other issues.  "Small government" conservatives will either have to get on board with CO and WA's right to do so (and to resist Eric Holder's goons) or stop claiming to be small government conservatives.  Furthermore we might finally understand what on Earth Holder has been doing, alienating some of the Dems' base in these states.  How to make sure it remains legal?  Invite states and localities to tax it, as has been done in Oakland.  They can't chill out every single small business.

- If the Dems are serious about staying partners with business (at least high-tech growth industries) then make a serious, concerted effort at smart regulation.  Yes, this will mean repealing and streamlining many regulations and maybe some departments.  The Obama administration has started to do this quietly but it needs to be much higher-profile to give confidence that it will be meaningful and that it will persist.  Staffing it with subject-matter experts who haven't spent their whole lives inside the Beltway will show seriousness in this regard; this can be done without letting foxes guard henhouses.  The FDA is a perfect place to start; implement some form of Andrew von Eschenbach's suggestion to make drug regulation about taking unsafe drugs off the market, rather than approving them before they can be sold.  (On the other side, the GOP is starting to look more like the party of big-business+government cronyism, and less like the party of capitalism.  Time to fix that before the Democrats take that away too.)


STATE - CALIFORNIA

- We need a balanced, sustainable budget, and that has to mean pension reform, in some form.  Now that the Democrats have a supermajority, we will know if this can be accomplished.  If either party has a supermajority, and can't pass a balanced budget, then California cannot ever pass a balanced budget.  I do not have high hopes for this and think the state government will see tough times before any real reform ever occurs.  We will hear reasons for why it couldn't occur, but the point remains that even with a state-congressional supermajority, they will likely not pass a sustainable budget.  I hope I'm wrong about this.

- Other considerations are secondary.  It would be nice to see gay marriage having official recognition but in a state that's degrading its parks and universities because it doesn't know how to balance a checkbook, such otherwise important questions become ancillary considerations.


CITY - SAN DIEGO

- Is public transportation really that difficult?  Yes, it's damn near impossible to put a real light rail system in (and San Diego doesn't have one) once an area develops, but is a real bus system really that expensive to develop?  My hope is that the local transit systems like UCSD's are putting enough people in place who see the value of one, and will vote accordingly in the future.

- For a California city, San Diego has a curiously unaccountable police department, with questions about officer-involved accidents and shootings often going un-answered.  Curiously in this mayoral election, we had a gay Republican facing a Democrat favored by police.  Filner's administration may not change this.

- If the Chargers want to build a new football stadium, that's fine, but to ask for taxpayer dollars to do it is absolutely unacceptable.  Filner is on record saying he opposes this - let's keep his feet to the fire in case he has some magical change of heart - and in any event, there is no evidence that stadiums help their local areas economically (in actuality they hurt).

Let's Be More Like West Virginia

"Only 1.1% of the state's residents were foreign-born, placing West Virginia last among the 50 states in that statistic. It also has the lowest percentage of residents that speak a language other than English in the home (2.7%)." From Wikipedia.

"Let's be more like West Virginia!" I encourage the nativists of the U.S. to adopt that as their rallying cry. Catchy!

Note also that a) West Virginia is the eastern- and northern-most member state of the Bad Stripe (most recent post here), and b) never having had as strong an agricultural component to its economy, WV's population is 3.5% African-American vs. 20.5% for VA, which by most accounts has performed slightly better.

Immigration is Recruiting, Not Charity

This is a message that needs to be repeated more. Pithy summaries: Jim Manzi said "we should reconceptualize immigration as recruiting." Reihan Salam adds urgency: "Incredibly, during a time when we’ve come to appreciate the importance of talent agglomerations and intangible assets, we’re reducing rather than increasing the legal influx of skilled migrants." We're only offering one third the skilled visas today that we did in 2001. Limiting skilled visas and granting amnesty to illegals has the same effect as blocking skilled labor and encouraging low-value labor. Not only are you selecting for low-value labor but you're creating an (ethnically defined!) service sector underclass which - progressive white collar Californians don't like to recognize - we already have. This is not good for the economy, and not good if you want a functioning democracy either.

All I can add here is an entreaty to the national Republican Party to include solutions to this issue in their platform. The GOP is really missing a big win here by ignoring this as a campaign issue and focusing instead on anchor baby idiocy. Refocusing the immigration issue in this way will also repair some of the damage to the GOP brand caused by anti-immigration support coming from open racists who taint the party's image - where as if you're for encouraging smart immigration (which will, by the way, largely be from eastern and southern Asia) you're self-evidently not a racist.

It's possible to find a real issue that has substantial economic and national security impact that can also resonate with voters, and this is one. It is tragically being ignored.

Undocumented Harvard Student Not Deported

Information here. Is there any irony to be had in the near-universal public indignation about a different kind of "undocumented" Harvard student being thrown out of the university? ("String him up! Oh, he's an illegal immigrant, not an illegal applicant? Well, um, I guess that's different then.") Forgive the condescension but it's indicated where questions are studiously avoided by those of us who don't like to question our assumptions.

Here's one angle: is there a moral difference between those two situations? Furthermore, is the U.S. right to selectively keep an undocumented (foreign national) Harvard student but not a 52-year-old landscaper? (Answer: yes.)

Immigration and Power

Background facts you need to appreciate this story:

1) In response to the new immigration law, Los Angeles City Council voted to boycott trade with Arizona.

2) LA gets 25% of its power from Arizona.


Emphasis on the fightin' words is mine:

An Arizona Corporations Commissioner responds to LA Mayor Villaraigosa with an open letter: "If an economic boycott is truly what you desire, I will be happy to encourage Arizona utilities to renegotiate your power agreements so Los Angeles no longer receives any power from Arizona-based generation. I am confident that Arizona's utilities would be happy to take those electrons off your hands. If, however, you find that the City Council lacks the strength of its convictions to turn off the lights in Los Angeles and boycott Arizona power, please reconsider the wisdom of attempting to harm Arizona's economy.

People of goodwill can disagree over the merits of SB 1070. A state-wide economic boycott of Arizona is not a message sent in goodwill."


Full story here.

[Added 20 June 2010: Cal Coast News rounds up the large deals with Arizona companies that many of the more rhetorically overheated California city governments have quietly consummated since getting on the bandwagon. The boycott seems to have disappeared down the memory hole.]