The New England Journal of Medicine is at it again. It just published a dire warning that deporting illegal aliens will hobble our healthcare system.
First, the authors give a dubious example of the kind of calamity that will supposedly happen to our most vulnerable patients without illegal immigrant workers. From, “Who Will Care for America?”
As physicians, we have witnessed firsthand the harms that such policies pose to patients and health care workers alike. In one case we know of, an older patient with metastatic cancer fell at home and lay on the floor for days before being found by a family member; he died shortly after being admitted to a local hospital. Though it’s uncertain whether he would have lived had he been found sooner, his home health aide had stopped coming to work for fear of deportation. Such tragedies illustrate the dangers that the current political climate pose to immigrants (whether documented or undocumented) who interact with the U.S. health care system.
Refusing to meaningfully distinguish between legal immigrants, who certainly perform key functions in the healthcare system, and illegal — who shouldn’t have those jobs at all — drives me (and many others) crazy. It impedes a meaningful discussion of the proper role of immigration.
The authors bring up legitimate concerns:
The United States has already been grappling with severe health care worker shortages, which are projected to worsen over the next few years. According to the Bureau of Health Workforce, the physician shortage is expected to increase from 12% (124,180 physicians) in 2027 to 16% (187,130 physicians) in 2037. Among primary care physicians, the projected gap is even wider — growing from 18% (50,100) to 27% (87,150) in that time frame.
No one is talking about deporting nurses, doctors, and other medical professionals who are here legally, which most are. They fill vital roles and more could be allowed into the country with few objecting.
The authors’ real focus is on less skilled health-care employees. They write that “37% of foreign-born direct care workers who are noncitizens, nearly half may be undocumented.” So, that’s roughly 18 percent of this sector’s workers. Are we supposed to allow these people work illegally, and just shrug? Moreover, their very illegality creates the unreliability of performance that the authors bemoan in the above example.
The authors trot out the trope that few Americans will be willing to take such jobs and complain about wage theft against illegal immigrants currently filling those roles. No. Increase pay for this difficult work and Americans and legal immigrants will take the jobs. But as long as a significant percentage of these services are performed by exploitable people, necessary reforms will never happen.
And notice that the authors ignore the deleterious consequences of the “anything goes” immigration mentality that created the current mess, including increased strains on our health-care infrastructure caused by millions of people who shouldn’t be here. Isn’t it amazing how that part of the story rarely gets mentioned by open-borders apologists?
The authors conclude:
Although much remains uncertain, it’s clear that immigrants are — and have always been — a vital part of the United States and its health care system. Immigration policy must therefore protect the dignity of people who dedicate their lives to caring for others. The recent deportation of immigrant health care workers is our canary in the coal mine: policymakers must act swiftly, or risk endangering the health of us all.
No. Enforcing the law is not a canary in a coal mine. It is the necessary predicate to restoring trust in the immigration system itself. Doing so will a stable and legal approach to allowing willing workers to come to the U.S. to improve their own lives and serve the needs — health-care and otherwise — of the American people.