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The Road to Serfdom:

Here's what an article in this week's issue of The Lancet suggested. (Note that this was covered in the New York Times; The Lancet is a very prominent medical publication.)

Although the active recruitment of health workers from developing countries may lack the heinous intent of other crimes covered under international law, the resulting dilapidation of health infrastructure contributes to a measurable and foreseeable public-health crisis. There is now substantial evidence of state and organisational involvement in active recruitment of health workers from developing to developed nations.

There is no doubt that this situation is a very important violation of the human rights of people in Africa. In recent years, international law has developed the notion of international crime to strengthen the accountability of individuals for serious violations. One indication of the gravity of acts and that they deserve treatment as international crimes that has been developed by the International Criminal Court is that they create social alarm. Active recruitment of health workers from African countries is a systematic and widespread problem throughout Africa and a cause of social alarm: the practice should, therefore, be viewed as an international crime. [Emphasis added.]

What a way of looking at the world -- though of course nothing remotely new. Your country needs your medical services. Therefore, it's wrong for others to steal you away from your country, since you're the country's property. In fact, this theft is an international crime.

That's what the logic amounts to, it seems to me, though of course for all the best of intentions. The proposal doesn't just call on rich organizations (or even rich countries) to fund medicine in poorer countries, or to teach those countries how to provide medicine more effectively, or to reduce regulatory barriers to good medical care in those countries. Rather, it tries to use international criminal law in a way that blocks people from moving towards a better life for themselves and their families (including their families back home, whom they can support through remittances) -- to keep people where they supposedly belong, in the place that's entitled to their services and to coercive government action aimed at preventing the loss of those services.

Now it's true that the proposal doesn't (yet) cover "passive" recruitment, which is to say simply hiring someone who comes from a country that needs the person more than you do. The article reports: "We, of course, recognise that while there is a right to health for everyone, there are also health-workers' rights to consider. Health workers should have freedom of movement and choice of where they live and work, just as any workers should."

But surely this "active recruitment" doesn't consist of sitting on people's doorsteps and nagging them until they break down and agree to move to a richer country. The health workers who move in response to the active recruitment are exercising their freedom of movement and choice of where they live and work. The active recruitment simply informs them about where the opportunities are, plus helps them lift barriers to the exercise of their rights (legal barriers, by providing "legal assistance with immigration," and economic barriers, by providing "guaranteed earnings, and moving expenses"). It makes no sense to say "of course, we recognise your rights to freedom of movement and choice of where you live and work; we'll just make it an international crime for people to lift legal, economic, and informational barriers to your exercise of those rights."

And the logic of the proposal surely casts into doubt even the health-workers' right to move entirely on their own. After all, the rationale is that "Without immediate actions to discourage migration, the health consequences for Africa are dire," and "Current international treaties and commitments are severely compromised if we are unwilling to adhere to their principles and prevent obvious harms to poor people." The consequences are "dire" and the "harms to poor people" present even if the health workers emigrate without outside "entic[ement]," for instance when they learn about opportunities and get legal and economic help from relatives or friends rather than from recruitment agencies.

Once you take the view that it's an "international crime" to urge or to help someone exercise his rights, you've undermined his practical ability to exercise his rights, and you've also gone a long way towards denying his moral entitlement to those rights. That is the road to serfdom, with each medical professional being the property of the lord of his manor (the local government, though of course speaking on behalf of the people).

Thanks to Michael McNeil for the pointer.

MXE (mail):
My guess is that there's a double standard here. Basically, wealthy (Western) nations and organizations are held to a higher moral standard than the "natives" so to speak. Therefore it's possible to fault the former for making an offer, but not to fault the latter for taking it.

After all, if you take away the "we evil white people are always just exploiting developing nations" meme, the absurdity of the "international crime" designation becomes instantly apparent.
2.25.2008 12:54pm
Mark Buehner (mail):
if you take away the "we evil white people are always just exploiting developing nations" meme


If you could do that, the socialists the run the UN would be out of things to say.
2.25.2008 1:05pm
Richard Aubrey (mail):
No, I don't see any evidence that Lancet would cook any books to make a political point. Nope. None at all.
2.25.2008 1:07pm
George Tenet Fangirl:
Is this really all that different from, say, cracking down on agricultural businesses that hire illegal immigrants? If the right of workers to go wherever their best prospects are is inviolate, then immigration laws should be abolished. Otherwise, the Lancet's position could simply be modified to "it should be illegal for medical workers to emigrate" and there would be no objection.
2.25.2008 1:12pm
Smokey:
The Lancet, formerly above reproach, has been discredited. The large infusion of George Soros money has predictably resulted in the corruption of the Lancet.

Today, the Lancet is no more credible than Dan Rather.
2.25.2008 1:19pm
Eugene Volokh (www):
Fangirl: The difference is the difference between walls to keep people out (immigration restrictions) and walls to keep people in (emigration restrictions). There are problems with the former, but not nearly as grave as the problems with the latter -- among other things, the latter interfere with people's ability to move to any country, including those that are quite willing to have them.
2.25.2008 1:24pm
MXE (mail):
Also, I love how they can -- with a straight face! -- cite "causes social alarm" as a valid criterion for designating a practice as an international criminal offense. That is just so painfully British.

Truly, our brethren across the pond are the masters of "social alarm." Have you guys read about Brown's proposed ban on assault knives? God I wish I were joking.
2.25.2008 1:26pm
Mark Field (mail):
Hmm. I suspect I could oppose laws criminalizing drug use (prostitution), yet still think it morally suspect to recruit people to deal drugs (become prostitutes). Or, to take an example from US history, one might think slavery morally justified, yet consider slave trading a despicable profession.
2.25.2008 1:27pm
ithaqua (mail):
It's the brain drain theory again. The 'international crime' bit is particularly obnoxious, but the idea is nothing new; the same argument has been used for years by VDARE (warning: may be listed as a hate site) and other anti-immigrant think tanks, who claim that allowing immigration into the United States skims off the best and brightest from poor countries. If we just closed our borders, the argument goes, these people would have no better option than to stay at home and work to improve their country, making everyone better off.

The surprise is that the Lancet is endorsing this crap; in the past, that argument has mainly been the domain of conservatives. Perhaps we're seeing the birth of a new, anti-individual, anti-immigration alliance between left and right. What fun :)
2.25.2008 1:31pm
whit:
the lancet is right up there with CSPI and other supposed 'scientific' organziation/journals that use the veneer of science ('it's science so it's gotta be good') to disguise political hackery.

i have no problem with people making these arguments (even though i think they are wrong), but using a journal like this as a front for political actioneering is disgusting. it dilutes REAL science. and we all know it aint the first time lancet has used quasi-science to make a politica point.
2.25.2008 1:33pm
MXE (mail):
Mark, you make a good theoretical point; the only pitfall is that it requires comparing hiring people to prostitution or drug addiction. This doesn't help make Lancet's claims sound any less outrageous. :-)
2.25.2008 1:33pm
ithaqua (mail):
And to respond to Prof. Volokh's comment: there are certainly differences between immigration and emigration restrictions, but the particular argument being made - that restricting the free travel of individuals, from whichever side, benefits the countries from which the individuals come - is the same (and equally obnoxious) no matter which side it comes from.
2.25.2008 1:35pm
eddie (mail):
Professor you make much of the walls to keep out and walls to keep in analogy (or was that simply a description by example?); however, you seem to miss the point of your own high-lighted text: the law proposed was not against these "innocent victims" that you are suddenly moved to champion, but against the recruiters. But then, any restriction on the good old "free" market would be an anathema.

I think Fangirl gets it right: if there was adequate policing of those who are "harvesting the low hanging fruit" there would be no brain drain or immigration problems.
2.25.2008 1:41pm
Thoughtful (mail):
Thanks to the Lancet for creating another argument to limit the supply of physicians in developed countries, allowing further rent-seeking by physician political action committees.
2.25.2008 1:44pm
frankcross (mail):
There are obvious practical differences between immigration and emigration rules. But the theoretical way of looking at the world that the post raised -- "you belong to a country" seems pretty much the same.
2.25.2008 1:47pm
dearieme:
The Lancet has fallen into the hands of socialist fruitcakes - its views are barely worth discussing.
2.25.2008 1:50pm
Deoxy (mail):
"There are obvious practical differences between immigration and emigration rules. But the theoretical way of looking at the world that the post raised -- "you belong to a country" seems pretty much the same."

Really? "You have to stay in your own house" is the same thing as "You can't come into my house"?!?

That's what you just said. The difference between those things is not small, or even large - it is ABSOLUTE.

Any country has the right to keep other people OUT... what is being protested is the proposal that one may not invite others IN (or out of their own house, depending on how you look at it).
2.25.2008 2:00pm
Dave N (mail):
Yet another example of why the United States would be insane to ever subject it or its citizens to any kind of International Criminal Court (yes--I realize the United States could theoretically limit what charges could be brought against American citizens AND that only the nutcases at Lancet think this is a crime, but once the United States has agreed to international jurisdiction, it is only a small step to then agree to international idiocy).
2.25.2008 2:09pm
A.C.:
Why aren't African countries training extra health-care workers specifically to work in the west and send money home? Seems like the obvious solution, but I guess it would never occur to someone educated to have a socialist mindset.
2.25.2008 2:12pm
Fub:
The article reports: "We, of course, recognise that while there is a right to health for everyone, there are also health-workers' rights to consider. Health workers should have freedom of movement and choice of where they live and work, just as any workers should."
Isn't this the usual conundrum the left must inevitably tap-dance around?

The solution: wage controls and residential restrictions for "health-workers" in "rich countries". Make 'em work and live in poverty and squalor amid plenty, and they'll stop immigrating.

I'm shocked that Lancet would overlook this obvious solution.
2.25.2008 2:29pm
Vermando (mail) (www):
If the idea is that we do not belong to a country, can we do away with U.S. taxing of expatriate workers who live abroad? It does not force you to stay here, but it certainly gives you a strong economic reason to do so and is a very strong statement that you belong to a country. Hard to say you do not 'belong' to a Lord of the Manor if he says that you still have to pay him tribute even though you've moved out.

In that regard, I'd like to point out that the U.S. is the only industrialized country that engages in this practice, and I know of little outrage stemming from either left or right (excepting a few small anti-tax pieces from Heritage which were based more on a general anti-tax sentiment than the notions of freedom discussed above).
2.25.2008 2:29pm
Eugene Volokh (www):
Vermando: It's been a while since I checked into this, but my understanding is that if you truly sever connections with the U.S. -- move away, give up your citizenship, not keep any assets in the U.S., and not make any income in the U.S. -- the U.S. will neither try to tax you nor be able to do so (since you'll be effectively outside U.S. jurisdiction). But if you retain links to the U.S., the U.S. will continue to tax you because of those links. This may or may not be a fair or sensible approach (I haven't thought much about the subject); but it does not strike me as an undue burden on the freedom to emigrate.
2.25.2008 2:40pm
Thorley Winston (mail) (www):
What a way of looking at the world -- though of course nothing remotely new. Your country needs your medical services. Therefore, it's wrong for others to steal you away from your country, since you're the country's property. In fact, this theft is an international crime.


What you're describing sounds an awful lot like slavery whereby a human being is deemed the property of another and forced to work for the benefit of another. IIRC isn't human trafficking for the purposes of slavery actually an international crime (or at least haven't the major powers agreed via treaty to try to stop it)?

As far as the merits of the point made in the excerpt that's been posted from the Lancet article (note: I am still waiting on my registration to be approved so that I can read the entire article so it's possible that my opinion might change), while I'm sympathetic to the problems created by a shortage of doctors (we have that in rural parts of the United States but it's not nearly as problematic as many parts of the developing world), I'm generally in favor of people being able to seek out new and better opportunities to improve the lives of themselves and their loved ones with a minimum (not an absolute absence) of restraint by the state.

What I think we (by which I mean the United States, Canada, the EU and rest of the developed world) ought to do though is get rid of agricultural subsidies. Not only do such subsidies cost tax payers billions of dollars every year and lead to higher prices in food, fiber, and fuel but they prevent much of the developing world, particularly Africa, from being able to compete in the global market. If they were able to compete on a leveler playing field, they would bring in more capital which could them be used for improving their health care infrastructure or whatever priorities aren't being met as well as they should.
2.25.2008 2:55pm
shadrach:
Here's Richard Horton, editor of The Lancet, ranting at an anti war rally in 2006 to give you a flavour of his world view:

2.25.2008 3:16pm
shadrach:
oops Richard Horton:

http://youtube.com/watch?v=v7BzM5mxN5U
2.25.2008 3:19pm
The Unbeliever (mail):
and other anti-immigrant think tanks, who claim that allowing immigration into the United States skims off the best and brightest from poor countries... The surprise is that the Lancet is endorsing this crap; in the past, that argument has mainly been the domain of conservatives.


I kind of hate to make a quibble about labels, but what you're describing is an economic argument, not a conservative one. It describes a consequence of a policy, not a rationale for implementing it; it is based on the expected behavior or outcome of imposing a limit on the freedom to transact. It is a result of the Law of Unintended Consequences, and can be used as a data point by any side.

Conservativism as an ideology may oppose excessive or illegal immigration (or in some extreme cases all immigration), but you will be hard pressed to find a mainstream conservative source who used this argument as an actual rationale against an open borders policy. It should be obvious why one would cite this phenomenon when listing out the pros/cons of such restrictions; it lets conservatives sound like liberals when it comes to internationally "making the world a better place".

But hey, like any bit of economics, you could argue it both ways. [Insert your favorite economist joke here.]
2.25.2008 3:19pm
TerrencePhilip:
Should it also be declared an "international crime" for Mexicans to work in the United States?
2.25.2008 3:22pm
Mark Field (mail):

Mark, you make a good theoretical point; the only pitfall is that it requires comparing hiring people to prostitution or drug addiction. This doesn't help make Lancet's claims sound any less outrageous. :-)


Well, "hiring people" is pretty much what prostitution is. I wouldn't make it illegal, but I doubt I'd defend it much either.

To me, the better argument is to ask what externalities might be generated as a result of behavior and ask whether the market is adequately handling them. The Lancet seems to recognize a problem but is ignorant of how to address it.
2.25.2008 3:23pm
AnonLawStudent:
Mark,

Your argument re: externalities makes the same mistake as the Lancet piece. The term "externality" implies an impact on third party rights or property. No third party rights are affected here - no person or country has the right to the services of another human being. Just because there is a collateral effect to an action doesn't make that effect an externality.
2.25.2008 3:56pm
A.C.:
Most arguments about group rights are wrong, and this one is no exception. People can have social groups all they want, but no social group (nationality, ethnicity, religion) gets to own its members. That kind of thinking is the wrong way around.
2.25.2008 4:04pm
Ralph Phelan (mail):
If we just closed our borders, the argument goes, these people would have no better option than to stay at home and work to improve their country, making everyone better off.

If that was the primary motivation for restricting immigration you might have a point. But in my experience I hear that argument far, far less often than I hear variants on "They're stealing our jobs!"
2.25.2008 4:06pm
bonhomme (mail):
Well, "hiring people" is pretty much what prostitution is.
Wow. What an unserious thinker you are. Prostitution is the business of performing sexual acts for money. If you can't make the distinction between the superset of paying a person for services and the subset of paying a person for sexual services I don't know why people should attempt further argumentation with you.
2.25.2008 4:06pm
Bruce Hayden (mail) (www):
I think that the answer to the article is that there are probably physicians involved in the publication of the article, given that this is a medical journal, and if so, then they should start off by moving to sub-Saharan Africa, or comparable, so they can work for dollars a week with no equipment, and allow the physicians and other health care workers from those countries to come here and make a living wage.

Interestingly, in the current issue, this is the only article that does not have a summary, so that one could look at the credentials of the authors.
2.25.2008 4:14pm
Brett Bellmore:
IIRC, in many of the nations in question, it's essentially impossible to get a medical education without a government subsidy, one condition of which is that you will remain in the country practicing medicine. In fact, I've heard tell of doctors and nurses who've immigrated to this country, who can't return home to visit kin, because they'd be jailed if they did.

So, international crime? No, but it is a national in many cases.
2.25.2008 4:47pm
Mark Field (mail):

Your argument re: externalities makes the same mistake as the Lancet piece. The term "externality" implies an impact on third party rights or property. No third party rights are affected here - no person or country has the right to the services of another human being. Just because there is a collateral effect to an action doesn't make that effect an externality.


I agree that nobody has the right to the services of a specific person. Still, I doubt anyone would find it praiseworthy if Bill Gates had paid Mother Theresa to leave the poor of India to their own devices and serve as his spiritual advisor. Much as that might have benefited Bill....

Here's where we may disagree: I happen to think the poor of Africa do have a right to basic medical care. Unlike the Lancet, I'm not going to criminalize the act of hiring away their existing physicians, but unlike some of those here, I'm not going to praise it either.

It does seem to me to fit the definition of "externality" (here and here), so it makes sense to me to think of it in that context. If I'm wrong about that -- and I might be -- that doesn't bother me much. It's the moral issue which concerns me rather than the specific word we use to describe it. In either case, as I said above, I'd prefer to solve the problem (assuming there is one) through the economic system rather than the criminal law.
2.25.2008 4:48pm
eyesay:
I agree that people have a right to leave their own countries and try to find work abroad.

But I share this The Lancet writer's view that active recruitment of health workers from African countries is a systematic and widespread problem throughout Africa and a cause of social alarm.

It's inflammatory and inaccurate to label it a crime, as this The Lancet article does.

But the situation in Africa is dire, and cannot be solved just by telling African countries to be more libertarian.

There are many countries in Africa where the under-five mortality rate is over 200 per 1000. In developed countries like the United States, the under-five mortality rate is well below 10 per 1000. This humanitarian crisis can't be solved by telling Niger to be more libertarian.

The toll of AIDS cannot be overstated. In many sub-Saharan countries, it is wiping out the productive class of educated adults, including teachers, doctors, nurses, and other workers.

About half the world's people live on less than $2.00 per day. Imagine how much more U.S. exports they would consume if they earned $4.00 per day.

Poverty is a complex system involving lack of resources, lack of health care, lack of education, lack of access to credit at reasonable rates, and much more. We should be investing in ending global poverty, not exacerbating it by weakening the already-fragile health care systems of sub-Saharan Africa.

The world is one big boat. If Africa sinks, it won't be pretty for us either.
2.25.2008 4:49pm
pct:
Re Vermando: If the IRS believes that you have renounced your citizenship for the purpose of "avoiding" taxes, it will continue to tax you for 10 years.

link
2.25.2008 5:13pm
AnonLawStudent:
Mark,

There is confusion over whether what exactly constitutes an "externality." Moral hazards, such as the subject of this post, and certain types of price increases ("pecuniary externalities") are frequently excluded from the technical definition.

You are right as to our subject of disagreement being the "right to medical care." The "right" to the services of another human being is commonly referred to as slavery.
2.25.2008 5:18pm
frankcross (mail):
It comes down to whether you consider people first individuals or parts of a country. A country is not a house. When we recruit people, we are providing them opportunities that they may exercise in their free choice. Rejecting this is saying that they should sacrifice their choice for their country. You can make that argument on practical economic grounds, but it applies regardless of whether we recruit them or not. When we keep people out, we are treating them not as individuals but judging them by accident of birth.
2.25.2008 5:20pm
Vermando (mail) (www):
Indeed, you can only emigrate without the U.S. retaining its claim to you by, as Professor Volokh says, renouncing your citizenship entirely, and even then, as pct says, the IRS will likely still demand taxes from you for the next ten years.

I find it amazing, though, that such outrage can be whipped up by the restrictions on emigration discussed in the Lancet article, but the requirement that you sever all ties forever with your home country is not seen as such an undue burden. To no longer be able to visit your family, friends, or home again? To not visit or conduct business in your home country, and renounce your very nationality on top of that?

It's not nearly as bad as what East Germany demanded - you physically can leave at will and provided you handled your deeds correctly you do not have to fear reprisals to your family - but it is similar in that once you have left, you have to really cut all ties, and that is an amazing burden for anyone to bear (just read some of the beautiful post-Communist Eastern European literature written after 1991). Moreover, it is certainly at least as much a restriction on liberty as the African doctors not being able to be actively recruited by Western healthcare companies.
2.25.2008 5:27pm
MXE (mail):
About half the world's people live on less than $2.00 per day. Imagine how much more U.S. exports they would consume if they earned $4.00 per day.

True enough. And which do you honestly think would make these people more productive and help them earn more money -- emigrating to functional, modernized economies, or being stuck working in a Fourth World failed state? (That doesn't describe all of sub-Saharan Africa, but it does describe a fair portion of it.)
2.25.2008 5:35pm
Bored Lawyer:

Indeed, you can only emigrate without the U.S. retaining its claim to you by, as Professor Volokh says, renouncing your citizenship entirely, and even then, as pct says, the IRS will likely still demand taxes from you for the next ten years.

I find it amazing, though, that such outrage can be whipped up by the restrictions on emigration discussed in the Lancet article, but the requirement that you sever all ties forever with your home country is not seen as such an undue burden. To no longer be able to visit your family, friends, or home again? To not visit or conduct business in your home country, and renounce your very nationality on top of that?


The problem with this overwrought argument is that it is simply not true.

One can freely emigrate from the United States to wherever you wish and set up shop as a butcher, baker or candlestick maker whereever you wish.

The more onerous requirements only apply if you want to give up all obligations to your home country -- including taxation.

Note that the U.S. has tax arrangements with many countries such that to the extent income is taxed in the country where it is earned, it is not taxed in the U.S. Further, I believe (tax lawyers correct me if I am wrong) that the first $75,000 of income earned abroad is exempt to the extent it is already taxed in the country earned regardless of tax treaties.

So for the vast majority of people who wish to emigrate from the U.S. and seek employment abroad, the restrictions of U.S. tax law mean little.

Where they do have a real bite is the very wealthy, who earn considerable profits from investments, and then seek to avoid U.S. taxes by renouncing U.S. citizenship. In that circumstances, I fail to see what is unfair, let alone outrageous, for the U.S. to say, if you really don't want to bear the burden of our taxes, then you have to sever your legal connection with the country.

(BTW, this does not mean the person is barred from the U.S. Presumably as a citizen of the new country, the person could easily apply for a visitors visa.)
2.25.2008 6:15pm
Bored Lawyer:
For those interested, the IRS sets out the law here:

http://www.irs.gov/publications/p54/index.html

Basically, there is an exclusion of about $85k in foreign income, plus a housing deduction of up to $37.57 per day ($13,712 per year). Obviously, the legal issues are bit more complex.

So, to sum up, one is free to emigrate to anywhere one wishes and work at whatever trade one wishes. But, so long as one is a U.S. citizen, one still has to pay U.S. taxes -- subject to a rather generous exclusion.

It is only someone who wants to stop paying U.S. taxes that has to renounce his ties to the U.S.

Hardly an unfair, let alone outrageous, position.
2.25.2008 6:28pm
alias:
This is truly frightening. I will bring this up whenever someone criticizes the US for not signing the ICC treaty.
2.25.2008 6:45pm
MarkField (mail):

There is confusion over whether what exactly constitutes an "externality." Moral hazards, such as the subject of this post, and certain types of price increases ("pecuniary externalities") are frequently excluded from the technical definition.


Fair enough, and they possibly should be (at least in some cases). As I said, though, I'm less concerned with the technical definition than I am with solving a real problem (health in Africa).


You are right as to our subject of disagreement being the "right to medical care." The "right" to the services of another human being is commonly referred to as slavery.


That's hardly fair in light of my previous posts.

Look, there is a long historical record of countries all over the world restricting the right of their citizens to emigrate. Even such a relatively free country as Great Britain had such restrictions (and may still, for all I know). I think those restrictions are wrong, but that doesn't mean I can't look for other ways to solve the problem.

In fact, Brett's post above suggests that there may be contractual or tort remedies available in some cases. That would be a much better way to proceed than the criminal law.
2.25.2008 7:49pm
ikarashin (mail):
My point in bring up the 'closed borders helps countries from which immigrants come' argument wasn't that it was a common, mainstream conservative argument, but that it was an utterly contemptible argument that, as Prof. Volokh said, treats individuals as the property of their nation and fellow-citizens. It is embraced by the dregs of conservatism, and, as you said above, normally spouted by dishonest individuals with no genuine concern for the inhabitants of foreign countries, which is why it annoys me so much that the Lancet is apparently embracing this rationale in good faith.

That being said, I can see why Africans - those stuck in Africa, that is - would be utterly enraged by people coming in from Europe or Asia and offering local doctors unimaginably large salaries, by African standards, to abandon them. People are, quite literally, losing their lives because of these recruitment drives. So it's an ugly choice - keep your doctors prisoner, again literally, or see yourself and your friends and family die from lack of health care - but not, I think, one that international law can or should get involved in. The precedents set by this could be ugly as well.
2.25.2008 7:51pm
ithaqua (mail):
(ah, that last was me. Thinking of a different login, sorry.)
2.25.2008 7:52pm
pushmedia1:
Do we know that those recruited out of Africa would have, in fact, become health care workers if there wasn't a possibility of them leaving Africa in the first place?
2.25.2008 7:59pm
ithaqua (mail):
Actually, let me follow up on that one last time. There really is an issue of privilege involved here; I do think it's more offensive for people in a position of wealth and power (Western countries, the ICC) to decree from outside that doctors shouldn't leave their home countries than it is for people in that country, suffering the lack of medical care directly, to make that decree; or, if perhaps just as offensive, it's at least more understandable. There's issues of not just public health but also homeland security involved in a lack of medical care, and even beyond that, 'freedom' and 'liberty' are abstracts. You can't eat freedom. Liberty won't set a broken bone.

Think of it as a country restricting liberty (of its people) in exchange for increased security and well-being (of its people); the conservatives here should be very supportive of that idea, right? I've seen it defended here enough...

BTW, didn't we plan on making it illegal to leave the United States without a passport? Whatever came of that?
2.25.2008 8:03pm
Andy Freeman (mail):
I'm confused. Let's suppose that the US regulated emmigration as suggested. How would that affect the "goodness" of the suggested restrictions?

Surely no one will argue that the US doing something is an arguement that said something is good. But if you're not going to make that argument, why bring up the US?
2.25.2008 8:11pm
American Psikhushka (mail) (www):
eyesay-

Poverty is a complex system involving lack of resources, lack of health care, lack of education, lack of access to credit at reasonable rates, and much more. We should be investing in ending global poverty, not exacerbating it by weakening the already-fragile health care systems of sub-Saharan Africa.

I'm skeptical of this explanation, the Soviets had natural resources, health care, and education in spades. I'm reminded of a quote by Warren Buffett - a bad business (as in bad economics) will always defeat good management. So in the economic realm it would seem a crummy economic system will always defeat (or at least severely hamper) whatever natural and human resources a country or area possesses.

So it would seem that those wishing to help these economically troubled areas should be focusing on what libertarianism tells us is fundamental - a functioning legal system that protects individual and property rights that can form the basis of a free market in these areas.
2.25.2008 8:12pm
Ricardo (mail):
If this argument is to be taken seriously, it's only a small step to saying that the recruitment in African countries by local big city hospitals is also a "crime" since that will also draw doctors and nurses away from the rural communities where they are needed.

Additionally, telling Africans that they have no hope of ever working abroad if they study medicine or nursing is a great way to encourage the citizens of African countries to not study these subjects at all.
2.25.2008 8:21pm
American Psikhushka (mail) (www):
ithaqua-

My point in bring up the 'closed borders helps countries from which immigrants come' argument wasn't that it was a common, mainstream conservative argument, but that it was an utterly contemptible argument that, as Prof. Volokh said, treats individuals as the property of their nation and fellow-citizens. It is embraced by the dregs of conservatism, and, as you said above, normally spouted by dishonest individuals with no genuine concern for the inhabitants of foreign countries, which is why it annoys me so much that the Lancet is apparently embracing this rationale in good faith.

While I suppose the argument can be made disingenuously, it can also be made honestly as well. But you also seem to be mischaracterizing the argument. Many conservatives or libertarians are not arguing for other governments sealing their citizens in, they're just arguing for more control over immigration by sealing our borders. Which isn't outrageous - most countries have at least some controls on immigration. I have not seen the argument made in the sense you're suggesting - that other countries should seal their citizens in because they "own" them.

And also note that some of the other observations that go along with that argument are somewhat accurate. If the most energetic, ambitious, hard-working, etc. residents are continuously shipped out of the country it does function like a "safety valve" for the statust quo, since these types of people usually are the bulk of the motivation behind calls for reform, change, etc.
2.25.2008 8:45pm
Uthaw:
2.25.2008 9:06pm
A. Zarkov (mail):
EV:

"… but my understanding is that if you truly sever connections with the U.S. -- move away, give up your citizenship, not keep any assets in the U.S., and not make any income in the U.S. -- the U.S. will neither try to taxyou nor be able to do so…"

According to this article in Forbes, the 1996 law on taxing expatriates was tightened up in 2005. It's pretty draconian.
Under the new law, which is retroactive to June 4, 2004, anyone who expatriates and has assets of more than $2 million or paid more than $620,000 in federal income taxes over the five years before leaving is presumed to have left for tax reasons.
snip

"Expatriates who don't fit one of these narrow exceptions will owe U.S. income tax on a wide range of U.S. source income and estate and gift taxes on U.S. assets for ten years. If they spend more than 30 days in the U.S. during any one of those ten years, they'll be taxed that year just like U.S. citizens, on all their income from any source."
Snip
Don't come here for medical treatment; if an expat dies in a year where he's spent 30 days or more here, his entire estate is subject to U.S. estate tax.
Now get this:

A separate 1996 law bars citizens who expatriate for tax reasons from returning to the U.S.
The US plays hardball when it comes to taxes. Government ain't no fun without lots of money.
2.25.2008 9:17pm
Elliot123 (mail):
Recruiters are simply a form of information. Information about opportunities in the West is reaching people in undeveloped countries. I suppose imformation about opportunities in engineering, accounting, and computer science also reaches these people. If so, the same international crime is being committed by hirig engineers, accountants, and programmers.

A simple solution would be to limit the information flow to undeveloped countries. If they don't kow about the opportunities, then they can't take advantage of them, and the native country gets to keep its talent.

The highest priority task would be to cut off internet access. The internet lets any enterprising third world profesional apply for available jobs in the West. The situation with these third world types is always the same: give them a little bit of informaton and they always get in trouble.
2.25.2008 9:20pm
A. Zarkov (mail):
This policy sends the following message. "Don't become a doctor because if you do so you become property of the state. Will this really help medical care in Africa? It might keep some doctors from leaving in the short run, but eventually it will make the shortage even more acute.
2.25.2008 9:30pm
Brooks Lyman (mail):
"Active recruitment" - I presume that's something like what the Arab slave traders do, only done by foreigners?

And while dying of any illness is wrong, if it can be avoided, much of the "AIDS" in Africa is simply mis-diagnosis of local tropical diseases, which are quite bad enough, thank you. If more effort were placed on proper (as against politically correct - in Europe and America) diagnosis and treatment, many lives would be saved.
2.25.2008 10:03pm
JB:
This is typical of a lot of thinking.

"X is a problem!" (Yes, the 3rd-world brain drain is a real problem)
"Something must be done about it!" (We'd all be better off in the long run if Africa had more health-care workers per capita)
"Let's ban X!" (Yeeeahh...that'll really work, and be just.)

The line of argument that goes "X is bad, let's ban it" is very common, from drugs to abortion to unpleasant speech to high insurance rates to this. It's made by people with no knowledge of game theory, who assume that people won't change their actions in response to differing conditions, and by people who don't care about game theory and just want to see the laws reflect their own preferences, regardless of what actually happens.

The philosophical difference between this way of thinking ("disapproval lawmaking") and the way espoused by most VC members and commenters ("Results lawmaking") is deeper and more crucial than the liberal/conservative divide. Sadly, we're in the small minority.
2.26.2008 12:19am
Andy Freeman (mail):
> even beyond that, 'freedom' and 'liberty' are abstracts. You can't eat freedom. Liberty won't set a broken bone.

However, freedom is more likely to produce sufficient food. Liberty is more likely to result in MDs who want to be where they're needed.
2.26.2008 2:37am
MXE (mail):
You can't eat freedom. Liberty won't set a broken bone.

Well, you can't eat ICC decrees either, and left wing sanctimony has crappy bedside manner.
2.26.2008 3:07am
A.C.:
Somebody mentioned government scholarships above. Although I find the whole Lancet argument ridiculous, there is some merit in attaching a service requirement to government-provided education. Military academies here work that way, and there doesn't seem to be any outcry about the military "owning" the graduates.

Five years of work in-country might be reasonable, especially if a person (or recruiting employer) had the option of repaying the scholarship in order to take more profitable work abroad. A really enlightened scheme might allow people to work abroad for personal gain and remittances, but to spend sabbatical years doing public service work at home. Not everybody is motivated entirely by profit, but few people are saintly enough (or rich enough already) to ignore it completely.
2.26.2008 5:10am
Brett Bellmore:

It might keep some doctors from leaving in the short run, but eventually it will make the shortage even more acute.


It might occur to you that, were African governments averse to instituting policies with long term bad effects, (Heck, even short term bad effects!) the doctors wouldn't be leaving in the first place.
2.26.2008 7:46am
Andy Freeman (mail):
> A really enlightened scheme might allow people to work abroad for personal gain and remittances, but to spend sabbatical years doing public service work at home.

Instead, these folks are threatened with prison if they return. Of course, that's the fault of outsiders.
2.26.2008 8:08am
Andy Freeman (mail):
> Liberty won't set a broken bone.

Lack of liberty has a way of causing broken bones.

However, that's okay if they have free healthcare....
2.26.2008 8:10am
Visitor Again:
It's all very well to claim the moral high ground when you are a country that's wealthy enough to lure vital talents from the third world. But when allegedly paramount national interests are at stake, the USA would be no more willing to allow free emigration to other countries. Atomic scientists from the USA seeking to emigrate to the Soviet Union during the Fifties? Forget it. Not comparable, you say? It's a matter of life or death in both cases.

This country has its own long history of interfering with the freedom of movement. It won't even let its ordinary citizens travel to Cuba, 90 miles offshore. It won't even let native Cubans residing in the USA make a yearly visit to their relatives in Cuba. It criminally charged one of the world's great chess players for playing a match in Europe. It yanked the passport of one of the world's great singers and actors, Paul Robeson. All this under the rubric of national interests.
2.26.2008 9:40am
SG:
Visitor Again:

Unless you're arguing that the US was right to do those things, you are reinforcing, not detracting from the basic point being made.
2.26.2008 12:04pm
A. Zarkov (mail):
"Atomic scientists from the USA seeking to emigrate to the Soviet Union during the Fifties? Forget it. Not comparable, you say? It's a matter of life or death in both cases."

Someone with a clearance for Secret Restricted Data (atomic secrets) who sought to openly emigrate specifically to the USSR in the 1950s would in effect have been announcing a defection. No country allows someone to defect with military secrets. So yes there is no comparison.

Atomic scientists could and did emigrate, even when under suspicion of being a spy. Ted Hall was a physicist on the Manhattan Project and he emigrated to the UK in 1962. He was under suspicion for having passed classified information to the Soviet Union while employed at Los Alamos. Actually it was more than suspicion. The Venona decrypts fingered him as a spy, and he admitted passing information in a CNN documentary in 1998. He was not charged with espionage to avoid compromising Venona.
2.26.2008 12:59pm
Elliot123 (mail):
"This country has its own long history of interfering with the freedom of movement. It won't even let its ordinary citizens travel to Cuba, 90 miles offshore. It won't even let native Cubans residing in the USA make a yearly visit to their relatives in Cuba."

Well, we can fix that keeping those third world folks in their place. They are actally happier that way.
2.26.2008 4:52pm
Korea Beat (mail) (www):
Sure, The Lancet's proposal is unworkable and would probably have all kinds of deleterious consequences. But everyone working themselves into a lather of outrage might do well to keep in mind that we're coming from the perspective of a buying country in the physician market, and moreover, the perspective of people who live very long and healthy lives already. It's hard not to believe I would feel much differently if I was from a poor, unhealthy country and watching my country's best doctors getting bought up.
2.26.2008 7:17pm
A.C.:
Poor, unhealthy people are in a tough place regardless. If they are to get health care at all, somebody has to pay. It might be the government or a charity. But the demand here is that the doctor should pay by forgoing the opportunity to earn income elsewhere and provide for his or her family. Some of whom might end up poor and unhealthy as a result.

This is not likely to increase the supply of doctors.
2.27.2008 12:06pm