As the online Concise Encyclopedia of Economics puts it:
The law of unintended consequences, often cited but rarely defined, is that actions of people–and especially of government–always have effects that are unanticipated or unintended. Economists and other social scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it.
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Most often … the law of unintended consequences illuminates the perverse unanticipated effects of legislation and regulation.
http://www.econlib.org/library/Enc/UnintendedConsequences.html
The perfect example is, of course, the travel ban: Rushed out without consulting anyone at State or DOJ or any other experts who could winkle out some of the likely consequences and try to ameliorate them; implemented chaotically, leaving the front-liners to figure out what the hell to do; throwing untold thousands of lives and livelihoods into limbo.
Much of the media focus has been on the people blocked on the cusp of coming to the United States, stranded abroad, or those afraid to leave, fearing they too will never be able to get back. But, of course, the effects of the ban ripple way out from those folks, and one wave of consequences is going to roll over Trump’s most fervid supporters:
Rural white folks.
Yes, indeed. People, for example in South Dakota, where doctors like Alaa Al Nofal fill a crucial gap:
At his pediatrics practice in Sioux Falls, South Dakota, Dr. Alaa Al Nofal sees up to 10 patients a day. He’s known some of them since they were born. Others, he still treats after they’ve graduated from high school.
“I treat these children for Type 1 diabetes, thyroid problems, thyroid cancer, puberty disorders and adrenal gland diseases,” he said.
Al Nofal’s expertise is critical. He is one of just five full-time pediatric endocrinologists in a 150,000 square-mile area that covers both South and North Dakota.
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A Syrian citizen, Al Nofal is in Sioux Falls through a special workforce development program called the Conrad 30 visa waiver — which basically waives the requirement that doctors who complete their residency on a J-1 exchange visitor visa must return to their country of origin for two years before applying for another American visa. The Conrad 30 waiver allows him to stay in the U.S. for a maximum of three years as long as he commits to practicing in an area where there is a doctor shortage.
After President Donald Trump issued a temporary immigration ban restricting people from seven Muslim-majority countries — including Syria — from entering the U.S., Al Nofal is unsure about his future in America.
It’s not just Dr. Nofal who’s at risk:
Over the last 15 years, the Conrad 30 visa waiver has funneled 15,000 foreign physicians into underserved communities.
Sanford Health has 75 physicians in total on these visa waivers and seven are from the countries listed in the executive order. “If we lost Dr. Al Nofal and our other J-1 physicians, we would be unable to fill critical gaps in access to health care for rural families,” said Sanford Health’s Morrison.
And the ban could hurt the pipeline of new doctors, too. The Conrad 30 visa waiver program is fed by medical school graduates holding J-1 non-immigrant visas who have completed their residencies in the U.S.
More than 6,000 medical trainees from foreign countries enroll every year in U.S. residency programs through J-1 visas. About 1,000 of these trainees are from countries caught up in the ban, according to the American Association of Medical Colleges. J-1 visa holders who were out of the country when the ban went into effect were prohibited from entering the U.S. and unable to start or finish school as long as the ban is in place.
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“The stress and concern generated by the short-term executive order could have long-term implications, with fewer physicians choosing training programs in the states and subsequently magnifying the deficit in providers willing to practice in underserved and rural areas,” said Dr. Larry Dial, vice dean for clinical affairs at Marshall University’s school of medicine in Huntington, West Virginia.
http://money.cnn.com/2017/02/10/news/economy/visa-ban-rural-doctor-shortage/index.html
So will thousands of American-born doctors now flood into these bastions of Real Americans to take all those jobs stolen from them by those invading visa-holders?
Thanks for posting this. I’ve been wondering if there was an issue here, given the demographics I personally see among local medical providers.
Something big could be made from this.
Of course, it does rub up against the antipathy some people have to foreign-born doctors, who’d rather have Real Americans do their doctorin’, thankyouverymuch! Or perhaps that ship has already sailed, been hulled by reality, and sunk with all hands.
Lived in an area that was a patchwork of small towns. I will say that the only competent doctors I ran into were the ones who were foreign born. The rest? I wouldn’t want them anywhere near my dogs. I’m sure the locals resented having foreigners in their midst, but they weren’t going to get medical attention worth much of anything (or medical attention period) otherwise.
at least here in California that ship has sailed, and returned loaded to the gunwales with foreign MDs. My job is medical database, and the list of providers looks like the U.N. Of course especially here, a Chinese or Vietnamese name doesn’t mean you immigrated.
I believe my Kaiser doctor is foreign, but I never asked.
I agree that in CA the names don’t mean anything. One of my jobs in the non profit I’m involved in is listing everyone, over and over. And….OMG the names! We sure ain’t in Kansas.
It’s a MAJOR bug with me when idiots talk about immigrants. They have no idea. None.
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I think that ship has sailed (great metaphor) too, but I am wary of a California-based view. However it’s been true everywhere I’ve been, many Drs & other health professionals retain the accent of a non US origin.
There are plenty of white docs-to-be in US medical schools (the majority of them may now be female?).
However, demand for mds in the US probably outstrips the very limited supply (one of the worries voiced about ACA). A friend in med school says that many American classmates are “to the manor born” – maybe their network or other factors gets them higher quality jobs or more choice. They don’t have to go to Buffalo Jump Montana for a job.
I don’t know – a lot of anecdote and speculation – hope someone is looking into it. Sounds like there’s a real issue here though.
There’s been a doctor-shortage issue for a while now, most acutely in the ranks of primary care — the less glamorous and definitely less well compensated specialty in medicine. Other fields are also confronting the reality of looming shortages, even as many doctors age out of the workforce along with their patients.
http://www.aafp.org/news/practice-professional-issues/20150303aamcwkforce.html
https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_projections_04052016.html
There are a number of issues contributing to the problem, some of which a functional Congress could address.
Yeh, right.
White docs can be immigrants too. My former nose doctor was from Italy. He had his Italian diploma on the wall next to his University of Illinois diploma. He was older than I and now is retired. I joked with him before my surgery “now don’t hurt my fine Italian nose!”
Actually his first name was Elio, a Northern name, and at my first appointment he said “<my surname> that’s a Southern name isn’t it?” (“the dimmycratic party ain’t on speaking terms with itself”, neither is the nation of Italy.)
My current nose doc is from the Ukraine, his wife is a psychiatrist and has her office across the hall.
I heard on Michealangelo Signorile’s radio show the other day that 40% of US doctors are foreign. That’s way too high relative to the population. Why can’t Americans go to Med School without being millionaires’ children?
This set of radio stories is on subject. Please listen to these outcomes of the Executive Order, and the views of a wide range of people with experience and expertise on the subject.
This section is persuasive to me. From the transcript of the audio:
Ira Glass
When I tried to make sense of this radical change in our immigration and anti-terrorism policy over the last weekend, I came across this article on a website that’s devoted to national security law, called Lawfare, by the site’s editor-in-chief, Benjamin Wittes, who I learned is usually pretty hawkish on national security issues. And he noted a bunch of things that bothered him about the executive order. He said that the drafting– like the actual language, the writing of it– was inept and made it prone to legal challenges. He called that, quote, “a birthday gift to the ACLU or anybody who wanted to challenge it.”
But the most interesting thing he said– he let out this argument where he said that if the real purpose of this order is to stop terrorists, like it claims, it’s not going to achieve its goals. He says he didn’t believe it was the executive order’s real goal. He said if stopping terrorists was its goal, then the order is, quote, “wildly overinclusive and wildly underinclusive at the same time.” On the underinclusive side, Wittes notes that the executive order doesn’t stop people from lots of countries that might be just as likely as these seven countries to have terrorists. And on the overinclusive side, he says the order bans all kinds of people that it shouldn’t, people we have no reason to suspect of being connected to terrorism. I had him read.
Benjamin Wittes
It for the purpose of the order is the one it describes, for example, I can think of no good reason to burden the lives of students individually suspected of nothing who are here lawfully and just happened to be temporarily overseas, or to detain tourists and refugees who were mid-flight when the order came down. I have trouble imagining any reason to raise questions about whether green card holders who have lived here for years can leave the country and then return.
Ira Glass
Because of that, he writes, “I don’t believe that the stated purpose is the real purpose of this executive order. In the rational pursuit of security objectives, you don’t marginalize your expert security agencies and fail to vet your ideas through a normal interagency process.” He’s referring here, I guess, to the fact that the Department of Defense, State Department, Department of Homeland Security, and other agencies were not consulted in the normal ways before this thing was released.
He writes, “you don’t target the wrong people in nutty ways when you’re rationally pursuing real security objectives. When do you do these things?” he writes. “You do these things when you’re elevating the symbolic politics of bashing Islam over any actual security interest. This will cause hardship and misery for tens or hundreds of thousands of people because that is precisely what it is intended to do.” He writes that he doesn’t make this charge lightly. He’s never said anything like this about any other post-9/11 measures. But that, “whatever the White House is saying this is going to do,” he writes, “this will not help with terrorism, but it will keep out Muslims.” and he’s concluded that’s its purpose.
While getting rid of some Muslims was probably it’s ‘true purpose’, I believe what Bannon is after is maybe this?
In my opinion it fits. Eventually they want to end immigration (and possibly tourism) by everyone brown. It also fits in that it’s not something Trump would notice…they have him look at the neon sign of ‘Muslim ban’, but he misses the part of ‘everyone that comes here’.
The POTUS has large discretion on immigration issues. Read this article at VOX . It’s the EO annotated by an immigration attorney. Scroll down to the section where deporting immigrants that commit crimes is listed. It turns out ‘crimes’ covers everything, not just felonies (like Trump implied during the campaign).
It is possible for the administration to set up a system of ‘standardized vetting’ that forces every visitor….including green card holders….into committing a ‘crime’, forcing their immediate deportation (discussed elsewhere in the EO), and by the rules….once you violate your green card, you can rarely, if ever, come back.
This is where the rubber meets the road…..brown people are held in violation…other people get cut some slack.
How far did the courts go in stopping the EO? The whole thing, or just the Muslim parts? I somehow doubt a court would prevent a President from standardizing vetting requirements. And that might be why no appeal to the Supreme Court.
It’s what they wanted all along.
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Some truly terrifying implications you got there, all right.
On the other hand, it adds yet more hugely important economic sectors to the ranks of those who are going to want the orange emperor ousted for their own best interests.
I agree with janicket here. The broadest interpretation and enforcement of the EO would mess with global commerce way too much. They will defeat that enforcement level or see to it that Cheeto Benito doesn’t politically survive.
While I agree with both of you on the reality…I would remind both of you we are dealing with President Bannon and his minion. He ran Brietbart.com for gods sake.
They don’t care one shit about ‘international commerce’. They’re a wrecking crew.
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As BooMan wrote so pithily and accurately here in the middle of last year, “Trump is testing all our systems.” We need to do our part to make sure the systems which help the U.S. stay out of large-scale war and oppression hold up. The money men don’t want to bring back the Crusades; the question is if they will do enough of the right things to prevent it from happening.
You have a lot of faith in the ‘system’ and what’s called ‘checks and balances’. And with this comment you seem to have faith in the moral rectitude of ‘money men’. Or maybe instead of ‘moral rectitude’, it’s ‘economic self interest’ you think they will react to. Many are republicans…….lower their personal taxes, exempt them from capital gains, and end the inheritance tax and the ‘money men’ would stand by while Bannon and his crew burned brown people at the stake. Shoot, just tell the ‘money men’ you are thinking about those things and they would give you the matches!
Booman did a diary about appealing to Mormons… here is one of them now. Oops, here is another one
And let’s hear from another one..the libertarian conscience of the Senate. Have you ever seen a more whinny ass titty baby than a libertarian? Drama Queens….they want market forces to work..but prick them with a pin, and they run to their safe place and cry for Daddy to help them.
No ‘money men’ are going to step up, any more than a Mormon or a libertarian will step up.
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I’m not saying the business powers will step forward to defend moral decency or civil rights. I’m saying they don’t like instability, and that The New Crusades would be extremely bad for business.
But then again, climate change will also be very bad for business, and the business community hasn’t yet gotten its shit together to respond appropriately to that extremely pressing issue.
‘Economic self interest’.
OK, if you were a CEO, and a republican, which would you care about more, lowering your personal taxes, including capital gains (ahem….stock options!), or the actual profit and loss of ‘your company’? And don’t forget……salary and stock perks are pretty much completely disconnected from how a company does. Think Hewlett-Packard.
Now let’s say, rather than a CEO (small potatoes) your a true ‘money man’, like one of these guys, then you thrive on disruptions. Every time Trump tweets and makes a companies stock go down, someone profits. The true ‘money men’ are completely insulated from normal disruptions…in fact they make money either way.
There are billions to be made. And the money made with have less of a tax burden.
Nobody will step in.
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Money makes people jerks
Money makes money, and the money that money makes, makes more money.
Ben Franklin
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The travel ban and other proposed immigrant policy changes are bad for business. The New Crusades would be extremely bad for business.
Those are the instabilities I’m talking about.
I know, I know!
And what I am saying is personal avarice wins over business, every time (at least with republicans).
Nobody will step in.
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>>Think Hewlett-Packard.
OUCH!
you’re obviously thinking of Carly Fiorina, but here in silicon valley a lot of us remember that HP was for a long time one of the best managed and most admired (and profitable) companies in the industry.
i feel old.
“those days are gone forever, over a long time ago”
But Bannon has risen and will fall with Trump. I may well be wrong, but I don’t see His Trumpitude lasting even one full term, one way or another, and I also don’t see President Pence tolerating Bannon’s presence for a nanosecond after he takes the oath of office.
I think Bannon is gone relatively quickly, maybe before May. One too many ‘President Bannon’ from the media will do it. It’s obvious SNL is grating on the administration.
Trump isn’t going anywhere any time soon.
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>>They don’t care one shit about ‘international commerce’. They’re a wrecking crew.
hard to disagree, but “international commerce” means a whole fucking lot of money, enough money to be capable of protecting itself one way or another.
The entire Executive Order has been stayed by the courts. It appears the Administration is preparing a slightly altered EO which is more likely to pass Constitutional muster. We will see.
Whatever the final policy, it will be destructive of people’s lives and economic circumstances, including the white people who believe they will regain their privilege through these enforcements. The Trump Administration does not intend to increase the power and incomes of working people; they just want to be seen as doing something which “common sense” suggests will increase the power of working people. A multitude of other policies the Administration will engage in will see to it that workers will be even more dominated by their employers than they have been.
Too many Americans have been propagandized for too long. Too many people will continue to believe lies about and mischaracterizations of immigrants. Most of those Americans will disseminate the propaganda, as we have seen here at the Pond. It’s a damn shame. We’ll have to educate as many people as we can over the months and years, but we have been set back.
I saw that Vox report. Yeah, pretty fucking disturbing, particularly given that the majority in control of the Legislative branch will not act as a check on the Executive branch in this area. Only the thin reed of the Judiciary stands in the way of rule by racist decree until future elections give us an opportunity to turn away from kakistocracy.
Then we will see if that ‘standardize vetting’ part is
a) in it.
b) passes muster
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