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Notes -
What is the mechanism by which replacing foreign-trained doctors with native British doctors is supposed to make healthcare more affordable for patients?
My naïve assumption is that doctors from, say, the Indian subcontinent are willing to accept lower pay and less favorable conditions than comparable Brits, simply because the opportunity to live and work in Britain is worth so much more to them than it is to a native Brit who takes that opportunity for granted. This is, as far as I can tell, pretty uniformly the story of nearly all immigrant labor, skilled or unskilled, throughout the developed world. And presumably the ability to furnish such doctors lower wages and less benefits would in turn redound to the patient in terms of lower costs.
I’m extremely sympathetic to many of the arguments for deporting foreign laborers — even doctors — and thereby clearing the field for natives to move into their remunerative positions; however, the argument that it will make things cheaper for the end users of those services seems to be quite dubious. Perhaps I’m missing something. Am I wrong that Indian doctors accept lower pay and that this causes healthcare costs, ceteris paribus, to decrease relative to the counterfactual in which all doctors are white Brits?
I think there’s a lot of friction that arises from doctors of all nations attempting to minister to patients of all nations.
Supposedly there are stringent language tests and of course we have examples on this board that show some foreign doctors pass these tests with flying colours, but I’ve also heard lots of stories from close family of doctors just being completely unable to speak or comprehend basic English. And of course now half the patients don’t speak English, so all paper has to be massively duplicated in every language and then presumably translated for the docs. Likewise stories of doctors just repeatedly not turning up for appointments that they themselves booked with the patient.
Would an all English population of doctors be better? I don’t know but I’m pretty sure that replacing say the bottom 50% would help.
Sure, all of these are good reasons to want more white British doctors. But, other than the paperwork thing, which can’t plausibly represent some massive expense passed on to the consumer, what does any of this have to do with making things cheaper, which was the original claim?
To sketch a very brief case:
Time is money, translators are money.
Therefore mistakes due to miscommunication are money, as are delays for ever more extensive paperwork in ever more languages to prevent those mistakes.
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I will do my best to lay out my thoughts on the topic:
Speed Read: Arguments that immigrant labor accepting lower wages and benefits makes costs lower are strictly first-order evaluations that neglect both actual second and third-order costs, as well as the native populations perceived costs. I consider those perceptions to be a valuable signal to decision-makers that the economic data they are using to justify their decisions is in someway misaligned, or more likely, completely cooked.
There are a couple of reasons for my assertion. First, a tremendous portion of healthcare costs are known to be a result of senior care costs; Western governments in general, especially the UK, fund these costs via taxation and massive debt spending, which is inflationary. Senior care is a low status job, as is every job that used to be primarily sourced internally from within the family. Therefore, a proportion of the workforce engaged in senior care has been brought in from outside in order to provide this care. This workforce does not perform as well at taking care of the local population’s elderly, because they lack kin-based or even ethnic motivations to care for them, and also because they are doing it just as a job. The government has to attempt in some fashion to maintain quality of care as the workforce degrades, so it implements a typical state strategy, which is to create massive amounts of bureaucracy in an attempt to replace internal motivation with checklists, paperwork, and agencies. Because this is a long-term losing battle, the quality of care continues to degrade, but because bureaucracies are almost impossible to destroy, the money continues to flow in increasing amounts over time. Lower quality of care, greater cost for less output.
I will tangent here to say that the total size of the proportion of non-native British workers in the healthcare workforce is impossibly muddied by very foolish (or malicious) bureaucratic decisions to declare as “British” all sorts of people who are not native British. And this matters very much in terms of both cultural and economic costs. My people have been in the Lower 48 for going on 300 years, and yet we will never, ever be “Native Americans” from the perspective of actual Native Americans. I am perfectly fine with this, but I use it as an example of how two ethnes can maintain de facto boundary lines for hundreds of years, even in the face of significant forced government assimilation attempts. Just because non-British nationals make up 12% of the healthcare workforce, doesn’t mean that the native British ethne makes up 88% of the healthcare workforce. I would wager it is actually much lower than that and that this has significant cultural damage effects that contribute to raised costs, because the ethnes are different and in low-grade conflict with each other, despite an attempt to deny this by calling them all “British.”
Second, mass immigration of any kind appears to drive down the fertility rates and reduce the status of the original population. We can see this in conquests, colonizations, and, uh…the non-colonization mass immigration occurring for the past 50-60 years across the West. When fertility rates are low, the elderly have, tautologically, fewer children and grandchildren willing to share the burden of caring for their elderly relatives. That means that if care is going to be provided at all, it has to be provided by the healthcare industry/bureaucracy. This also increases costs, as you have to pay someone to do something that children and grandchildren might otherwise have been willing to do for free. It also increases costs because, if children and grandchildren are the ones actually providing the labor, they would likely be more inclined to let their elderly relatives die earlier (potentially leading to Nights of the Pillow, but I mean this mostly in a gentler sense). That is, it is easy to demand heroic and eye-poppingly expensive interventions that are in no one’s interest when it’s government doctors doing the work. It’s easy to make huge demands in spending when it is someone else’s money and time. Much harder to demand that when you actually see and deal with Grandma’s condition every day.
Finally, I also think that perception matters. Yes, as people point out, it is true that in the 50’s, houses were smaller and everyone only had one car, but the dominant ethne was confident and happy and this results in a productive and happy population, which tends to drive down not just actual costs, but perceived costs as well. If I have to pay $20 more for an appointment with a doctor who is visibly and understandably of my culture and people, that might be worth a lot more in knock-on cost effects overall than is immediately apparent from arguments of “it costs more!” Maybe I see the doctor less because I feel better helped at the first appointment, driving down costs by removing that appointment from healthcare expenses altogether. I’ve been using senior care as the most salient example and probably lowest hanging fruit, but I think that there is a good reason to believe that a hypothetical NHS of 2050, staffed nearly entirely with native British, serving a population of nearly entirely native British and prioritizing attention to that population over attention to non-native concerns, would be overall cheaper than the 2050 equivalent of current NHS.
This is my NHS specific argument.
This is a total tangent, but additionally, I also think that modern style immigration is very much the camel’s nose. Once you let in a genius Indian doctor, no matter how great a guy that dude is, the inevitable slide is towards more and more costs as a result of letting in more and more unqualified immigrants for any of a variety of reasons. This is why my argument surrounding immigration is that the government, as such, should have no significant control over it except for the following two rules.
I think this far, far better reflects the slow churning of peoples at the edges of territory that has occurred across all of human history, and keeps the ethne from stagnating without creating all the sturm und drang of post-60’s mass immigration ideology.
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