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Comment by jimbob45 | Hacker News Reader

Humana is starting to hire nurses in the Philippines. One would think that’s a national security hole but what do I know.

The first candidate to promise an outlawing of outsourcing gets my vote.

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Nursing was always dependent on Pinoy labor.

Because PH used to an American territory until 1946, the education system is largely the same [0].

PH is to the US Medical system as India/Pakistan/Bangladesh are to the UK NHS

[0] - https://nursing.uw.edu/article/filipinos-and-filipinos-ameri...

Indeed, Filipinos are a big part of the US military, and someone's worried about Filipino nurses being a security threat? Hahaha.

https://news.mit.edu/2020/philippines-us-military-alliance-0...

But I'm not sure how well the history of the US in the Philippines is taught even in gen-ed college history classes, let alone, say, high school. One of those topics I think most folks learn about either through personal interest, or as part of a history or politics major in college, apart from maybe a passing mention when covering the tail end of 19th century US history, or maybe a low-context entry in coverage of WWII. I guess it's not as bad as mistaking Puerto Ricans for "foreigners", at least.

> history of the US in the Philippines is taught even in gen-ed college history classes, let alone, say, high school

Depends on the state. I grew up in California, so Asian American history is extremely prominent since 1st grade.

Ah. Plains state here. Maybe that’s to California as Native American history was to us. That, the “age of exploration”, western expansion, very bad revolutionary war history, and the “cradle of civilization” (Mesopotamia) must, collectively, have represented 95% of all our time spent on history, K-6.

We have to import medical professionals (or hire offshored ones, for telehealth or whatever) if we don't want our healthcare system to collapse. We're gonna need to do a lot more of it as the years go on, too.

Too bad we can't import doctors. That's the worst bottleneck.

We're all gonna spend our twilight years being cared for almost exclusively by people who speak English with a heavy accent. The ball's been rolling that way for some time and it's got enough momentum that making anything else happen will take many decades.

It's like a health care ponzi scheme, what happens when the imports get old? The solution again is more imports. What about the source countries, did they not need medical professionals?

Same thing that happens to most who aren't doing pretty damn financially well in the US, I guess? All their savings gets siphoned into the system, then they die younger than they might have, and less comfortably than they should, unless family takes very good care of them? Then debt collectors try to trick anyone connected to them into paying for medical & other debts they aren't responsible for? The usual.

Anyway, worker visas don't have to be a path to citizenship, so this may fall, for better or worse, under "not our problem", depending on how it's all structured.

Which visa is that for the US? The ones I looked at are dual intent. I'm more familiar with the UK (NHS) where imports are expected to stay. I'm also pretty sure that the dual intent is part of the ability to pay under market rates where the immigration potential is a fringe benefit captured by the employer.

Honestly when the current crop of adults from the 'healthy at any size' era get old it's going to be a medical shit show, I'm pretty sure governments will end up resorting to Canadian style MAID for the poor, sick, and old as no-one will have the money for proper care.

Oh yeah, it’s gonna be real bad when the “our ‘thin’ people would have been considered fairly chubby 40 years ago” millennial generation (mine) gets old.

Science might be about to rescue us from that with Ozempic and friends, assuming those don’t turn out to do horrific things to a person over time. Once some of those go generic and the prices plummet, anyway. But failing that, yeah, it’s gonna be a lot of skinny immigrants helping obese, diabetic 70-year-olds with shot knees & backs get to the bathroom. Or maybe we’ll get robots for that, by then, go full Wall-E, who knows.

Yeah it’s the millennials I’m currently worried about, they’re also quite relatively poor so I suspect not many will be able to afford to retire let alone a high level of medical care.

I’m actually quite hopeful that ozempic mainly works by helping reverses hormonal damage caused by bad diets. Ozempic causes low gut motility which can be very unpleasant and potentially dangerous, there are already conditions with the same effects so it’s possible to benchmark what long term effects will be like (It’s not great). I think there are safe ways to do it and that will be figured out. I think it has already changed the culture for the better. I’m hopeful this high BMI era turns out to just be a phase instead of a one way ratchet. Where I live there are few overweight people so it’s always a bit of a shock to me whenever I travel.

I know that if you have a PhD it's way easier to get permanent immigration status than it is with a MS or BS.

I'd be surprised if the same weren't true for MDs.

Edit: it's an O-1 visa. To get one you need to show "special skills" in your area. For an academic (and I presume for physicians) that would be things like good research publications and so on. You have to be above the norm in some way.

The advantage of this visa class is apparently that it feeds directly into the green card system.

All of society has that Ponzi scheme dynamic, due to the declining utility of a human being as they age, and the extended time that they remain a net loss as technology allows them to live longer.

> Too bad we can't import doctors.

My current two doctors appear to be native speakers of English, but the previous four or five were all clearly from the Subcontinent or East Asia.

Note that I'm not criticizing them in any way... they were all perfectly fine doctors. I'm just wondering where OP is from that there aren't tons of imported doctors on staff.

Not can’t at all but the licensing hurdles can be really difficult if they didn’t go to med school in the US, as I understand it. Even from other countries that are clearly pretty good at educating & licensing doctors.

In Canada, the “brain drain” of Canadian-trained doctors to the US is very well known. It’s comparatively easy for Canadian doctors to start practicing in the US (much easier than the opposite).

For all this talk about "importing" human beings, why not "export" them instead? As in sending the patients abroad to be treated. Or is it wrong to uproot them to save some money?

Candidates can promise many things, but they won't pass laws to ban outsourcing. Even if they do, they dilute it to an extent that these laws become impotent by creative loopholes.

They might if the tax base decreases substantially and unemployment shoots up to unsustainable levels.

The government definitely cannot afford , with the national debt, to lose tax dollars or to subsidize high levels of unemployment.

What do you think nurses do that having Filippino nurses would be a national security hole?

You don’t have to outlaw it, just make it so economically painful as to be outlawed.

Oh, yes please!

As much as I would like labor laws to be improved Globally, I doubt governments will allow this.

That said, I am dying to see some country try something similar again. There is something beautiful when voters hold politicians up to their values, and politicans fail to explain the competitive realities to their voters.

Making outsourcing economically unviable is a magnicificent contender.

I don’t think outsourcing is the main problem with the American healthcare system. I encourage you to go a bit deeper and to not give your vote on a single bit of info. Try to expand to 1Kb.

I'm pretty sure there's something in HIPAA or SOC 2 that ought to be preventing people outside the US from having any access at all to US patient data, but Humana likely has more lawyers who know these things than I do....

I'm pretty sure you're wrong.

https://www.hhs.gov/hipaa/for-professionals/faq/2083/do-the-...

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