Prediction 5: The end of immigration

In the final version of yesterday's post (4 predictions for the next phase of the COVID-19 pandemic) I decided to omit prediction 5 "the end of immigration." The piece was already too long, I was running out of steam, and didn't want to be too political. Also, it seemed kind of obvious.And yet, I'm now kicking myself after the President's tweet last night announcing his plan to suspend all immigration. It didn't surprise me because it was something the President wanted to do anyway and the timing gave him two superficially plausible rationalizations: keep the virus out and reduce competition for American jobs at a time of huge unemployment.But it's a bad policy, especially now. Consider how immigrants are helping the healthcare system and the broader economy respond to the crisis.

1. Hospitals and health systems are overwhelmed, and we are counting on our physicians and nurses to save patients from death. Immigrants make up 28 percent of doctors and 16 percent of nurses. We don't really want to tell them they're unwelcome, do we?
2. Immigrants also comprise 20 percent of healthcare support roles, including nursing, psychiatric and home health aides.
3.  More than half of farm laborers, graders and sorters were born outside the US as are many of the people working in grocery stores, delivery, etc. They are needed to ensure a reliable food supply.

Immigrants have been a major source of innovation and job growth in the US economy throughout our history. We will need immigration going forward to create new jobs, help pay down the massive debt we are accumulating and to support the healthcare system. I've written plenty on this topic over the last 15 years.If you think the Health Business Blog is the wrong place to discuss  politics or you're a fan of the current Administration, stop reading now.*****Remember, you were warned...I'm going to peer a little farther down the road to speculate about where this latest action could lead. These aren't really predictions about what will happen, but I am pointing to where things could lead. These aren't about healthcare.On immigration itself, the administration will be happy with the debate, which will further pit the base against the urban elites. American universities will be further weakened by this policy (a follow on from my prediction 4 yesterday: "The federal government will grow even more powerful relative to everything else"). Others can come begging for temporary relief, e.g., farmers looking for migrant laborers.The next logical steps on immigration are deportation of people with green cards and the stripping of citizenship of Americans who were born elsewhere. The threats and hints will come first, and that may be enough to achieve the objectives. Remember, in late February the Justice Department created a Denaturalization Section to do this very thing.  Whether it goes further depends on how people react to the upcoming Executive Order and whether officials think it will help politically.It's quite possible that this latest, bold step will embolden the President to take further actions, including:

• Postponing the November election --in the name of protecting the safety of the population
• Ruling by decree -- since it's an emergency and Congress is too slow
• Closing down newspapers and others critical of him --since they are interfering with his message and the 'enemy of the people'

Yes, all of these are outlandish. But, how can you argue convincingly that they won't happen?

• We've already seen elections canceled, postponed or reinstated this year. At a minimum, expect strategic suppression of voting
• Congress has put itself on the sidelines by not meeting and by not changing the rules that require it to meet in person. Rule by decree has already come to Hungary
• The disdain for newspapers and desire for tougher libel laws has been made abundantly. Don't the 'enemy of the people' deserve some kind of punishment, especially during a crisis they've whipped up by writing 'fake news'?
• The President says his "authority is total."

I'll leave it there for now, except to note that what I've listed above is not all that could happen and not even the most extreme. The President wants to control the news cycle. That means doing something bigger than the pandemic to make it happen.-----By healthcare business consultant David E. Williams, president of Health Business Group.