How Legal Immigration Both Supports & Undermines America’s Healthcare System

My colleagues and I have written ad nauseam about the problems associated with illegal immigration: it’s bad for America’s economy, it causes social alienation, and, frankly, importing a large class of de facto serf laborers is immoral.

But lost in the cacophony are the (many) problems caused by legal immigration to America.

One such problem is the disruption of complex systems. Large-scale immigration, legal or illegal, opens up America’s labor market to exogenous inputs (those originating beyond said system), which can have unintended and sometimes detrimental impacts.

One such unintended effect is how the legal immigration of foreign physicians and medical practitioners has caused elements of our higher education system to atrophy from relative disuse.

Specifically, America’s universities can no longer train enough medical practitioners to meet the nation’s healthcare demands—America now relies on the immigration of foreign professionals to maintain its healthcare system, and standard of living.

Let’s get into the numbers.

America’s Healthcare System Depends on Immigration

First, let’s be clear: there are more physicians per capita in America than at any other point in time. There are also more nurses, physiotherapists, and mental health professionals. Aside from the potential issues posed by the iatrogenic effects of easy access to medical care, this is probably a good thing.

However, it’s also worth wondering how we got here: was the process organic, or artificial? Do we, as a country, actually have the educational infrastructure to train that many professionals, or are we living in a consumption bubble?

Unfortunately, America’s situation falls squarely in the second category.

In 1982/83 America graduated roughly 16,000 physicians. This number has barely budged since.

In fact, in 2015 America graduated just 18,705 physicians—that is, 17% more.

During the same period, America’s total population (not including the 11.1 million illegal immigrants) increased by 39%, from 231.7 million in 1982, to 322 million today.

In a closed system, we would have expected to see the physician-patient ratio deteriorate over the last few decades—but that’s not what we’ve seen.

Instead, we have more physicians than ever before. The reason? Immigration.

According to data from the Migration Policy Institute, nearly 17% of America’s 12.4 million healthcare professionals (including physicians, nurses, dentists, therapists) are immigrants to America. They more than make up for America’s training deficit.

Out of interest, the percentage of foreign-born surgeons, as a sub-category, is even higher, at 28%. For nurses, it is 24%. The data is unambiguous: America’s healthcare system needs immigration to function.

And of course, there is also the fact that an increasingly large percentage of students enrolled in medical school in America are foreign students, who often return to their homeland upon completing their education. This fact demonstrated clearly by the numbers:

Immigration is Destroying America’s Healthcare System

So you’re probably wondering: who cares? The legal immigration of physicians, and medical students, is clearly a good thing, since it provides us with a better quality of life.

I’m not denying that the legal immigration of skilled professionals can be a good thing. However, this type of immigration poses real system problems.

For example, there is an increasingly large language barrier between healthcare professionals and patients. The language barrier is especially pronounced in home nurses and home health workers. This can be a life and death problem—we should not scoff.

Of course, language barriers are a relatively minor problem when compared with the broader systemic issues caused by the legal immigration of healthcare. These are twofold: (i) the displacement of American students with more profitable foreign students, and (ii) systemic atrophy.

The first issue is relatively straightforward, and doesn’t warrant much discussion. Essentially, there are X number of spots in American medical schools, and an increasingly large percentage of said spots are allocated to foreign students, who are often charged extra (and are therefore more profitable).

This denies a large number of American students access to good educations and lucrative professions—all because of profit-incentives. This is, in fact, the primary reason why native-born Americans are being locked out of professional programs; it’s not that Americans are dumb, it’s that foreigners out-bid them.

My point is that America’s higher education system should work in our national interests, that is the promotion and education of American talent, rather than fleecing foreign billionaires.

My second point: America’s medical schools are atrophying, and our infrastructure is now wholly inadequate to keep pace with increasing demand. In the time before mass immigration, if America’s population increased, America needed to train more physicians. That meant more investment in universities and education, in better training programs.

Immigration provided a shortcut, and because of this our education system is 40-years behind. It is relatively small—we should be graduating over 22,000 physicians annually, and those physicians should not be moving back to China once they get their degree—and increasingly dilapidated—there is a strong preference for, say, Canadian nurses in American hospitals because our own programs are relatively poor.

We have the technology, but lack the training and competence due to decades of under-investment.

Immigration may be a shortcut to better healthcare, but it’s also a short-term solution. In the long run, we will need to invest in ourselves, and end the addiction to immigrant labor.