Why should medical personnel be seen as any different than other professionals who are headhunted for efficiency and have the right to seek the highest wage they can?
All the Yes points:
- Rich countries should actively recruit medical personnel from poor ones, and with this freedom must come the responsibility to reimburse them fully for the cost of their training.
- Economic Freedom In Action
- The Rights of the Individual
- Domestic trainees.
- Recruting ‘inactively’ is hypocrisy.
All the No points:
- Plan is too broad
- Plan promotes abuse by bad governments
- Plan unduly increases the control of the state over medical personnel
- Actively recruiting exacerbates brain drain
- Plan widens the research and development gap
- Plan creates more friction between richer and poorer countries
- Their plan is a failed Economic Model
- Welcome to the third world
- Harms and more harms
- Plan is a huge setback in human rights
Rich countries should actively recruit medical personnel from poor ones, and with this freedom must come the responsibility to reimburse them fully for the cost of their training.
The contentious word in the proposition is ‘actively’, remove it and the proposition effectively describes the status quo. At present rich countries patently do recruit medical personnel from poorer ones. Between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia are trained abroad, and lower-income countries supply between 40 and 75 percent of these international medical graduates. (N Engl J Med. 2005 Oct 27;353 (17):1810-8 16251537 (P,S,G,E,B,D)
This brain drain is, without question, an unacceptable form of intellectual colonialism that leaves developing countries bereft of vital healthcare resources, while allowing their rich counterparts access to their brightest and most highly (and expensively) trained minds with no compensation.
How is this global injustice to be rectified? There are two plausible solutions. The first, we might call the protectionist model, would seek to restrict the flow of medical personnel across international borders.
The second model, the one which we advocate, would replace the existing informal ad-hoc arrangements between individuals and healthcare providers that effectively sees poor countries pay the costs of training their medical personnel and rich countries reaping the benefits, with a formal market for medical staff. In this model rich countries would actively recruit medical personnel from poorer ones. But with this freedom would come the responsibility to ensure poor countries were fully reimbursed for the costs of their education.
This key change would align market forces with the interests of both sides of the contract.
Lo and behold, here comes our first agreement with the prop: we agree that the only difference between the status quo and the motion is the word “actively”. But the proposition, that should defend that same word, never shows us an active recruitment plan. The topic of the debate is whether there should be recruiting that is active, like for example as Australia recruits new citizens by going to other countries and organizing fairs about emigration to Australia opportunities. That is actively recruiting, but team prop. merely propose a compensation that comes after the doctor leaves, so it’s not active at all. Then comes this incredible pair of statements: “brain drain is unacceptable form of intellectual colonialism” followed later in the debate with “The only real distinction [between a lawyer leaving and a doctor leaving] would be their scarcity in some countries, but this cannot override the right of the individual to practice their skills in accordance with their preferences”. They at the same time label brain drain as “unacceptable” but then say people should be able to leave because of their individual rights”. But if something is unacceptable how can you accept the thing that allows it.This is the same as saying: To me abortion is unacceptable, but I respect a woman’s right to choose. We think that a brain drain it’s a very sad thing and we wish it didn’t exist, but it’s only a symptom of any country that doesn’t have a good enough situation for its brains to say “I will stay here with my people”. The brain drain is a consequence of a country’s bad political situation, rampant criminality, war, impunity and economic crisis, so a resolution to these is necessary to stopping the brain drain. Proof of this is that brain drains generally occur after these situations happen in any country but never where the opposite happens. Compensation will do nothing to stop this “unacceptable” thing. The other team proposes a false disjunctive since protectionism and compensation are not the only possibilities. Rich countries could invest the money intended by the proposition for compensation inside their own country and seek to reduce costs and they could also seek to train their own doctors on poorer countries.
Their compensation plan has two fundamental errors. First, countries need doctors more than they need money. Mere money won’t cure a sickness but doctors can. The proposition might say that a poorer country can hire and or teach other doctors but there is a need for the doctor now, not in eight years time, which is how long it takes to train another one. Another error: thinking a doctor’s value to be equal to their training. But most doctors will work for decades after graduation and the years of schooling and the place they take up until high school should be calculated as well. So if we though compensation was enough, which we don’t, the suggested compensation would be puny. The prop. could say that the compensation should cover all this, but this would render recruiting pointless as no matter how little med school costs, if we add all education starting from first grade, and we also add the health benefits that doctor would yield to the home nation throughout his/her life and we add the impact the professional would on saving human lives and improving quality of life then this very large sum would be comparable and even larger than the money it takes to train a national from the rich nation. We contend that either the compensation it’s insufficient or if it’s sufficient, then there’s no advantage in expending a lot of money buying a foreign doctor for its whole worth instead of training more local doctors at only the training cost of the rich country.
Furthermore tropical zones have different needs than colder zones, and since poor nations have many times a tropical climate they are ill catered to care for people in other climates. Of course in the SQ people cross temperature zones, but with the other team’s plan it will happen more since some countries will be tempted to farm doctors to send them. To retrain this people on things like frostbite and flu season, would cost money which should be added to any just calculation of compensation plus retraining. People in poorer countries are often trained in parasites and malnutrition, which are common ailments in poorer countries but not on rich ones, that knowledge would go to waste in rich countries.
Furthermore, as we explain later, there is no guarantee the compensation money will be used to create more doctors.
Economic Freedom In Action
A significant distinction between the three available stances on the flow of medical personnel is one of perception. Both the ‘informal’ (status quo) and our ‘formalised’ model are able to consider trained medics as a resource that a country has the option to export, and to maximise. We have said that the current system contains a reprehensible inconsistency: medical personnel are treated as resources, but at the same time are not fully paid for in a way that makes the exchange comparable to a mutually beneficial exploitation of comparative advantage. Our proposed model has the benefit of QUALIFYING the classification of medical personnel as resources, by the fact that they are fully paid for. Then, the migration of medics to richer countries becomes an argument we can make in fully economic terms.
To train a medic in the ‘poorer’ countries costs empirically less. Hence they have what we would call a comparative advantage in the production of a precious resource: medical personnel. A ‘richer’ country who seeks the use of such a resource does so at the best price available for maximum efficiency. In every other case where it is advantageous to do so, such cheaper resources are imported from the country which is able to supply it. In this case an investment, training, is required to produce the resource, but this investment IS COMPENSATED FOR as included in the economic cost of the import.
We would expect that the employment of our model would result, as it does in most other cases of comparative advantage, in an exploitation of this profitable exchange- in this case an increase in investment in training of medical personnel in those poorer countries. Of course an increase in the supply of trained medical personnel is of enormous benefit to the global community. The inevitable disparity in wages offered between countries would result in the similarly inevitable disparity in aptitude of trained medical personnel being expressed, as it is in all other labour markets, through wage differentials. There will be some medics trained in poorer countries for whom the salary offered in their home country will be appropriate and desired, as well as those exceptional medics, liable to appear in any country around the world, whose services are more desired and therefore capable of earning higher wages. For this they will migrate, and they have a right to, and the country they were trained in will benefit from having cultivated such a precious resource.
Our model is the expression of the international market for resources acting freely. If the motion were ‘Rich countries should actively recruit artists from poorer countries’ or ‘construction workers’, such an exchange would be considered laudable both on an individual level, which will be looked at next, and as demonstration of the efficient relocation of specialist workers to the place where they can be best rewarded for their human capital, and have the potential to actualise their training in the way that they most want to. On proposition side, we question whether medical personnel are any different, except for the important fact that their training may be compensated for and profited from, in a way that the status quo, with all other forms of economic migrants, does not account for.
The plan proposed will not in any way “make the exchange comparable to mutually beneficial exploitation of comparative advantage” because the poorer country doesn’t benefit equally since the cost of a doctor is not only his training. On top of what we just said in the rebuttal of their first point, just compensation also includes the cost of the lives a doctor or nurse won’t be able to save and as the evidence below about Africa shows it shall at least include the cost of replacing the expatriates by a foreign western doctor. Africa has lost a third of its skilled professionals in recent decades and it is costing the continent $4b dollars a year to replace them with expatriates from the West[[http://emeagwali.com/interviews/brain-drain/education-in-africa-brain-drain-problem-worldnet-africa-journal.html]]. Therefore, it couldn’t be clearer that investment couldn’t be compensated just by the cost of training. Even if poorer countries had a comparative advantage in training doctors, we have already discussed how the compensation scheme will either be insufficient or not competitive enough for it to be worth it, however, if rich nations started sending their med students to poorer nations they could pay the lower bill without taking away any doctors from that other nation. That way they will pay the low cost of a medical training and avoid brain drain of a country.
The proposition is wrong when they say a rich country will get the “product” (a estrange way to refer to human beings) at best price and efficiency. As for price, there is no better price than zero, which is the price rich nations are currently paying. How would having to pay from now own is the best price? And regulation, we’ll show, only causes less efficiency. They over-reach when they assume that the profit of the exchange will promote the investment in new medical personal, it might as well end up in a Swiss account or paying for a weapon purchase or any other activity. Besides, the government might not see any profitability in the production-selling (in the prop’s preferred term) of medical personnel, because as they put it, in their plan rich nations would only have “fully reimbursed for the costs of their education”, which implies that they pay for the exact amount for the training of the professional, without allowing the government any surplus, banning accounting tricks.
Stating that different wages always means different medic capabilities is a very simplistic way of expressing things by ignoring important factors in determining the wage such as working conditions, and the abundance or scarcity of a particular set of skills in a labor market. However, if they believe that the “disparity in aptitude of trained medical personnel” would be expressed “through wage differentials”, then when rich nations get cheaper doctors, they would arguably be getting less capable doctors. If they are getting less capable doctors, then the quality of care in the country would decrease as a result. In this scenario their solution is clearly suboptimal, since:
Rich nations would be better off training more high quality doctors at home than importing lesser quality doctors from poorer nations, as this would give them a higher quality of health-care and physicians trained on the locally relevant diseases. The Proposition has not showed why rich nations need to settle for less than top quality, and there’s no evidence on the table that suggests they are unable to make this investment, therefore this is the best option on the table
Poorer nations would be better off keeping their doctors and thus being able to cover their basic health care needs, so they can finally engage in their own research, improve the quality of life of their citizens and keeping the full value of their investment in human resources.
About workers or actors being no different from doctors, we have to agree, doctors are no different. Losing local talent is a problem whether it is engineers, scientists, nurses or actors who are leaving the country. They all matter. Even a massive emigration of farmers would also adversely affect a country’s economy. The consequences of losing local talent are recorded at least since the expulsion of the jewish and muslim population from Spain.
It’s an over-statement to say “our model is the expression of the international market for resources acting freely”: the compensation plan doesn’t establish any improvement to the international labor market for it doesn’t address the migration barriers, a real model of free labour market could be the Schengen agreement [[http://www.migrationsverket.se/infomaterial/om_eu/schengen_en.pdf]], this model has no similarities to it. Furthermore, it promotes that states use their power to intervene the market, creating situations were they could impose restrictions on doctors leaving because delay of the compensation, or governments that push their doctors to leave for earning compensation, or importing a large amount of foreign doctors to weaken the bargaining position of local doctors. We on the opposition side agree that free labor market is good and the prop. undermines it when they promote intervention in the market.
The Rights of the Individual
Side proposition advocate viewing the rights of medical professionals in the same way as professionals in any other field. A doctor has the right, as Aristotle would attest, to fulfill her full potential, or, in other words to have the freedom to actualise the initial desire associated with the choice of that field.
No-one would contest the right of a lawyer trained in X to avail themselves of the opportunities in Y, and we see no reason why the case should not be the same for doctors. The only real distinction would be their scarcity in some countries, but this cannot override the right of the individual to practice their skills in accordance with their preferences, which may include the highest salary they can earn. As with other professions, a factor of this preference could also include the very real differences in specialisation opportunity, research methods or practice culture, which may be accessed through relocation to other countries. It is beyond the remit of any observer to say that one criteria of preference may not be a higher wage.
To condone the view that scarcity in native countries of a particular profession supercedes what is a right of the individual to act on their preference would be to suggest that any scarcity of any profession warrants the prevention of the relocation of those people. A practical need, at any point where it should materialise, has the power to override the freedom of individuals. To follow this through results in a number of absurd conclusions- a citizen with dreams of America could enter a field, only to find that years later when she is qualified, she has enetred a category that is barred from exit.
You can leave a country, leave behind your house and all your riches and make it all again elsewhere if you have a wealth generating profession such as being a doctor. It’s not possible to claim to uphold individual freedoms and advance a policy that includes considering the profession of the individual not as his or her property but the country’s.
The other side may have predicted we would be defending that a country should defend itself from brain drain by closing the borders. If so, they were wrong. We do believe doctors as every other professional have the right to fulfill their potential, but the plan of the proposition does not bring this about, in fact, it doesn’t even get close to protecting the doctors right to achieve their potential or “actualise the initial desire associated with the choice of that field” since they are not part of the decision about their compensation. On the contrary, the doctor is a “product” that will work to meet the specialized needs in the buyer country.
It’s a reality that professionals leave their countries, because they are able to take advantage in other opportunities, but even though it may cause a scarcity of their profession in their country, that is part of the rights of the individual, whether or not they choose to stay. We are the real defenders of the right of the individual by defending the status quo, since we maintain the actual status where doctors are the decision-makers in their process of migration. In fact, doing the prop. plan will worsen the situation of the “right of the individual to practice their skills in accordance with their preferences”; since governments will manage the doctor’s market, in order to maximize their income, by producing doctors as if they where just some merchandise, or as the proposition calls it, a “resource”, means the government may not let them choose the specialty they want, but what the buyer is in need of.
It is not a good thing when a government thinks of itself as being entitled to charge for the migration of their inhabitants. They should see themselves as employees of their citizens, not their owners. In conclusion we are able to establish that since in their plan a country could prevent doctors from leaving the country because of the existence of the “doctor’s labor market of compensations” which is run by the governments, and controls who and when will have the opportunity and how much it will cost. Therefore, the right of the individuals is definitely NOT protected in the arguments of the propositions plan.
The final stakeholders to address are domestic doctors of ‘richer countries’ who are now placed at an apparent disadvantage. This disadvantage would come partly as increased competition for job placements upon graduation from training. This is something which is hailed by all as a great benefit to standards in the long-run. The second question would be whether as a graduate medic in a richer country I would see reduced opportunities by way of funding of research. However the answer here would be no, because richer countries are the ones that tend to export medical research, such as keyhole surgery for example. We would also expect that this would be the only place where nationality would become explicitly important, as it is only scientific descovery that a richer country would want to be asscociated with domestic personnel, therefore cost would be less of a factor.
They other team says that bringing doctors from abroad will improve quality standards in the long run, but it can cause exactly the opposite (remember when they said that difference in capabilities would express itself in wages differentials?). Countries can bring doctors for the sole purpose of reducing costs, not to improve quality. If the wages of national doctors are too high, countries are tempted to hire international doctors. International doctors come from different backgrounds, take different courses and have work experience related to specific diseases of their home countries. You cannot put aside the specific knowledge nationals receive in their education and training. At the end, if nationals are displaced by internationals because of greater price competition, quality can be threatened.
The proposition claims: “it is only scientific descovery [sic] that a richer country would want to be asscociated [sic] with domestic personnel” which is in fact not true. Countries can give more importance to the development of new technologies to protect their citizens and to the patents and income from new developments in research. In fact, research may have nothing to do with the nationality of the researcher, as the casde of german born Albert Einstein, making his achievements in the US.
The other factor the proposition blithely fails to see is the unability of the research industry to absorb all the national doctors that would be displaced. They also ignore the difficulties for doctors to instantly pass from practice to research, since both jobs in most of the cases differ significantly. Therefore, if the countries actively recruit medical personnel just to lower the cost and not to improve the quality, national doctors will have a hard time to find a job that would remunerate them for their specific knowledge.
Lastly, they admit “richer countries are the ones that tend to export medical research, such as keyhole surgery for example”, but they disregard the fact that their proposal will only exacerbate this problem. Since, there are not enough doctors in poorer countries to take care of basic needs (as currently admitted by representatives and specialists from the most developed countries like Louis Michel, the European Commissioner for Development and Humanitarian Aid[[http://europa.eu/rapid/pressReleasesAction.do?reference=IP/06/482&format=HTML&aged=0&language=EN&guiLanguage=en]]), research and development is relegated. The proposition may try to deviate your attention talking about the essential differences between doctors trained for practice and those that are researchers. However, the decision to dedicate yourself to practice as a doctor in a poor country has more to do with the lack of funding for research, than incapability or lack of interest in the dedicating your life to research. In fact, “Researchers in developing countries are poorly paid. Many have to work in private practice to make ends meet” [[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1118622&blobtype=pdf]]. To exacerbate this issue would be extremely harmful and it can even lead to a decline in the scarce research already being done to cater the needs of poorer nations as we further explain in our 6th argument. Active brain draining is certainly not the solution.
Recruting ‘inactively’ is hypocrisy.
Another unsatisfactory aspect of the status quo, that would be addressed by richer countries ‘actively’ recruiting medical personnel from poorer ones, is the pretence of rich countries that the resulting damage done to donor nations is not their responsibility, as things stand.
They are not to be blamed if doctors and nurses from poorer countries beat a path to their door; all they are doing is offering them the opportunity to better themselves.
No, far better, we believe, to encourage richer countries to accept their responsibility for the negative effects of this trade, as a first step to correcting them. It’s high time these shady deals were brought out into the light and formalised, as our proposal advocates.
We the opposition don’t think there is in the SQ any responsibility that can be pinned on rich countries. Bizarrely the proposition admits this (albeit in a whole different argument so maybe we can’t expect consistency) saying that: “The primary agents are the doctors themselves, so the rich state that benefits has done nothing wrong, and there are no grounds on which they could be made to pay compensation.” On the other hand of course there is damage in brain drain (BD) but responsibility doesn’t come from damage if the cause of the damage lies elsewhere. If someone beats or starves his child so much that he escapes his home to go to his neighbor’s is the neighbor responsible for the escape because he offers to adopt him? We think not. The other side could say, using this same example that the child will leave his home for any offer of a better economic situation, to have the change to ride a better bike. But the truth is children have to cross a certain threshold to even think about leaving. So do adults. The mere offer of more money is mostly not enough. There have to be a certain lack of attachment. But if done actively, if the neighbor looks to brainwash the abused kid or he goes to take him from his house he is co-responsible. Poorer countries need to accept responsibility as a first step to correcting them, which is difficult to do if the plan is implemented since you are only compensated when you have done nothing wrong. A final point is that active, as they describe it in their plan (compensation) doesn’t mean fairness. The attempt of the other team to pass the cost of the MP as fair compensation, ignoring their actual value is something that if done by a country would be worse than hypocritical, it would be insulting.
We’ve shown that the primary cause of the brain drain in medical personnel is economic migration, and therefore we have advocated an economic solution. We evidenced this by demonstrating donor nations weren’t characterised by the corrupt nature of their governments, criminality or persecution, but merely by the comparative economic advantage afforded by lower labour costs.
Such economic migration is as old as humanity. It cannot be stopped particularly in the case that the would-be migrant has a readily saleable skill, as here.
Because Opposition have not accepted this, to our minds inescapable truth, this debate has been fought on exceptionally narrow, actually rather tediously so, terrain.
In spite of their outraged rhetoric, on close inspection the Opposition’s main problem with our case does not amount to a principled objection to the flow of doctors out of their impoverished mother country, accepted as a status quo that must be rectified, but rather a practical objection that says our measure will make it worse. Opposition’s acceptance of the status quo, a passive drift of medical personnel to richer countries, represents a massive concession that reduces our burden to proving that our measure can mitigate the current injustice even slightly. We chose to use the market, given our analysis that the primary reason for emigration of doctors is an economic one. We identified the current injustice to boil down to the fact that a poorer country makes an investment and the return accrues elsewhere. So we advocated a formal market, where the wealthier state could become the active trader, seeking out cheaply trained medical personnel and treating this exchange as a purchase.
We cited the important example of the Phillippines, whose enlightened administration saw the folly of opposing the most fundamental of human instincts to personal betterment, and chose instead to work with it. By the simple expedient of encouraging their medical personnel to work abroad and send some of their earnings home, they were able to enjoy an increase of national income of 10%. At a stroke this turned an iniquitous, debilitating drain on a nation’s resources, into a massively positive contribution to its financial health and a boon to the rest of the world.
This is the model we seek to export; this is the context in which, we believe, rich countries should actively recruit medical personnel from poorer ones for the betterment of all.
Plan is too broad
The plan has left some important specifications aside that need to be addressed which include the free will of the “resource” (meaning doctor) to return to its origin country or just move to other country balanced against the rights the rich countires may think they have bought. Let’s imagine possible scenarios for this subject, the doctor has applied his skills in the country for say, a year, as any person may feel homesick and decides to return to his homeland, once returned the options are:
1. The hosting country is fully reimbursed the compensation money.
2. The hosting country receives no reimbursement at all.
3. The hosting country receives a partial compensation.
In the first scenario the poorer country need to worry about this and keep this money in an untouchable fund for this cases, then they really can’t use compensation money and invest it freely begin training a substitute doctor with the compensation money. If we look at the other side of the coin and the poorer country is not forced to reimburse, that means the rich country has to consider that money as sunk cost or consider itself as deceived ,since it can’t controlled the desires, dreams or a free willed person to fulfill his potential anywhere else but the investing country, unless of course the rich considers itself the owner of the foreign doctors, which again objectifies people and hurts human dignity. Well other arrangement that the opposition didn’t consider is a possible partial compensation given to the extension of the doctor’s service this plan is ripe to bring lots of confusion, administrative costs, red tape and bureaucracy.
There are no clear definitions of poor country and rich country and how a country can be classified. Only the word “poorer” in the motion. Thus, what happens with a Brazilian doctor who migrates to Poland (a richer country) and after a short while decides to move to Germany (an even richer country), should Poland be compensated or the doctor must stay in Poland for a period of time, or restrict his free will to move or migrate wherever the doctor pleased? We think this would be approaching a commerce of slaves. Moreover, the competition between rich countries to actively recruit doctors, as proposition stated could lead to stifled immigration and the integration between these countries and also will change the face of this noble profession as doctor will become mercenaries.
What happens if a doctors that works with an NGO goes to a richer country to help there? Lets say a Venezuelan doctor goes to a disaster zone in USA, such as New Orleans after Katrina, with MSF-Médecins Sans Frontières, would the US have to compensate Venezuela for this doctor services?, if so, then emergency relief efforts would be undermined. Also, the plan fails to recognize the professional who wants to relocate permanently, from those who are just doing others things, such as tourism, or volunteering.
One last point is vocational change, a doctor once exposed to a new culture realize that he no longer wishes to service as a doctor and wants to become an artist, the hosting country will not receive his service as expected and the country doesn’t owe the person and his desires or will, and the change of vocation is a probable scenario then what happens with the investment made, will it have to be reimbursed lest the person has to be deported for fulfilling other potentials other than medicine?
The other team could negate their burden of figuring these details, but we contend there are not details at all. These are questions that define their plan as one with more or less chance of, if not stopping the brain drain but increasing it, providing a small compensation. We think that their proposal is too broad to even decide that the small compensation would come with so many strings attached that it would be totally rendered neutral. Of course in other points we argue that it has the potential of not only not compensating but being extremely harmful.
First things first: rebutting their rebuttal.
Before setting out some further advantages of rich countries actively recruiting medical personnel from poorer ones under the circumstances we have described, we will first point out a number of apparent misapprehensions in the opposition’s attempted rebuttal.
Let it be noted again that they have said the following:
“The other side may have predicted we would be defending that a country should defend itself from brain drain by closing the borders. If so, they were wrong… We are the real defenders of the right of the individual by defending the status quo”
It is this point that drastically reduces our burden of proof. All they are left to contest us on is whether or not enacting our international legislation to create a formal market for medical personnel by requiring richer countries to compensate for the cost of production of a doctor is a good thing. All we need to prove to satisfy them is that this extra measure will improve not exacerbate the problems associated with a brain drain.
If doctors are state trained, the state is making an investment in order to see a return, in this case health provision. If this return is reaped by another country, this is what is unfair about the current system. The primary agents are the doctors themselves, so the rich state that benefits has done nothing wrong, and there are no grounds on which they could be made to pay compensation. A formal market reframes the above exchange as a poor state making use of its comparative advantage, and receiving compensation for THOSE DR’S WHO CHOOSE TO LEAVE. Opp’s characterization of a state run market for doctors is obviously ludicrous. The government are hardly going to force medical personnel out of the country to ship them off for profit.
So, in that mind we reply to their rebuttal:
A primary flaw in the opposition’s argument, from which a host of subsequent errors derive, can be discerned in the following analysis:
‘The brain drain is a consequence of a country’s bad political situation, rampant criminality, war, impunity (?) and economic crisis, so a resolution to these is necessary to stopping the brain drain.’
Such extraordinary circumstances can, of course, result in large-scale migration but they are not necessary at all for a brain-drain to occur. Brain drains are economic phenomena, and are therefore susceptible to economic solutions. When the Labour Government increased marginal taxation on high earners in the 70’s in Britain, for example, it presaged a brain drain to countries with more favourable tax rates in the absence of war, rampant criminality or even impunity, whatever that may be.
This fatal error of analysis on the part of the opposition leads remorselessly to numerous further false conclusions, perhaps exemplified by the assertion that ‘compensation will do nothing to stop this “unacceptable” thing’. Were it true that brain drains were the exclusive product of wars, rampant criminality etc., then this conclusion would be valid. But, as the example given above amply demonstrates, since brain drains are, in truth, economic phenomena, they can readily be stopped by the simple expedient of rebalancing economic incentives. Thus, when the British Government removed punitive rates of taxation, the UK brain drain promptly dried up.
Opposition goes on to say our insistence that rich countries compensate poorer ones for recruiting their medical personnel has two ‘fundamental errors’. ‘First, countries need doctors more than they need money. Mere money won’t cure a sickness but doctors can.’
We say this is an obvious false dichotomy, again resulting from a failure to engage with economic reality. You can’t have any doctors, or nurses, without money to train them. Money may not cure a sickness but it will pay to train someone who can. On the other hand we have the status quo: no money and no doctors; no health care provision at all.
Our second ‘fundamental error’ turns out not to be fundamental, but a matter of degree. Opposition now seem to be arguing that we cannot set our rates of compensation at a level that both makes economic sense to the richer nation and gives adequate compensation to the poorer one.
Let’s test this assertion with the example of Kenya. It costs the Kenyan people $66,000 to train a doctor; $43,180 to train a qualified nurse. And yes, contrary to the opposition’s assertion that such matters are beyond calculation, this does take into account primary and secondary education. (For the record in the case of a Kenyan nurse, primary schooling accounts for $10,963; secondary school for $6,865 and tertiary training in nursing, $23,352.) [www.biomedcentral.com/1472-6963/6/89]
In contrast it costs the UK tax payer between $300,000 and $375,000 to train a single doctor – between five and six times as much. [Hansard 10/3/06] Differentials in remuneration are proportionately immense. This is why opposition’s objections don’t add up. Even if the UK were to pay Kenya double or triple the entire costs of educating a doctor there, it would still be a bargain for the UK and a massive boost to the Kenyan economy. It’s a straightforward guns and butter exchange.
We can see the potential benefits of such an approach by looking at the example of the Philippines, where the government has long determined to train health workers for international export with extraordinarily beneficial results for their economy and the health of the world, according to the World Health Organisation: “The government of the Philippines has encouraged temporary migration by its health professionals in recent years and taken measures to turn remittances into an effective tool for national development by encouraging migrants to send remittances via official channels.” [The World Health Report 2006: Working together for Health. Geneva. 2006 p101.]
Even without formal or binding agreements of the kind we advocate, in 2004 in response to these ‘encouragements’ the Central Bank of the Philippines reported total remittances of US$8.5 billion, representing a staggering 10% of the country’s entire gross domestic product! (Source: as above)
Clearly in this context any measures taken to increase this mutually beneficial exchange are to be desired, and active recruitment on behalf of richer countries in the form of advertising, careers advice, symposia etc. is precisely such a measure and it is on this basis that we advocate it.
Finally we come to opposition’s claims that our proposals are impractical. They cite the case of the doctor who leaves her country of training but decides to return home, or the Brazilian nurse who migrates to Poland and then to Germany. How could we possibly accomodate all such eventualities without drowning in red tape and legal costs?
We don’t need to speculate whether or how this apparently intractable problem might be solved because it has been solved already quite routinely by companies and institutions that pay the costs of their employees’ training in return for a commitment to remain in their employ for a specified period of time. If the employee changes their mind and wants to change careers they simply buy themselves out of the contract by reimbursing their employer. If they do so after a year or two, they repay a proportion pro rata. Once they have ‘worked off’ the cost of the investment they become free agents.
Not only are such contracts easily framed, they are essential for the provision of educational grants, for without them companies and institutions would lack the security necessary to make the investment in the first place. Imagine the alternative: a company investing all that money in a potential employee only to have them dance off into the sunset as soon as they graduated! As ridiculous as it sounds, this is the reality of the status quo in the labour market for medical personnel, with poorer nations the ones left footing the bill.
Plan promotes abuse by bad governments
The proposition’s plan can be described as a compensation system in which a rich country’s government pays a poorer country’s government for the migration of doctors that flow in the opposite direction. Even if the poorer country’s government does not directly control the outflow of doctors, it may certainly affect the conditions that motivate the migration. It could reduce wages for doctors, impose controls over private provision of health services, introduce red tape for bureaucracy related to the practice of medicine, revoke licenses for “surplus” doctors, or any other institutional element that may motivate doctors to migrate to other countries, leaving the government with a significant amount for each doctor that leaves the country.
A myopic government focused on hastily putting it’s hands on money for, let’s say, crushing the opposition or a neighbor country, may take such decisions and leave the country with insufficient doctors to meet the basic public health needs. There’s simply no guarantee that the raised money will be used in the health sector, or even in any other meaningful priority, since most of the poor countries have transparency and institutional deficiencies that allow for corruption in the administration of State resources. Of course, that is the SQ, but the proposal would create the perception in governments of poorer countries that they can dispose of not only the cash they have in the bank, or the oil in the soil, but of the brains of people.
Usually, medical unions have a strong bargaining power with governments. This is positive because it works as an educated balance of government power in the design of the public health policy. One of the collateral damages bred by the plan is that it leaves medical unions with a shrunk bargaining power in front of the government, which may present a “do this or leave” attitude, since it would be profitable if the latter happened. In the end, more room for discretionary and arbitrary policy making by the government would arise with reduced power of the medical unions.
The proposition says that “This key change would align market forces with the interests of both sides of the contract”. This is one of the major blunders in their case, since the decision of migrating is not a contract among governments, but an individual decision of a citizen trying to find a better economic and social environment where to live. Their plan creates a compensation system among governments, so the impact on people’s migration comes after a certain action by the governments. In this context, the increased abuse and interfering by the poor country’s government on the health system would undermine the rights of the individuals in comparison to the status quo, for it would lead them to take a decision (migrate) that they may have not desired in the very beginning. This is a remarkable fact, since the “Rights of the Individual” is a priority in the proposition’s case.
A question in this debate is: Who’s responsible of migration? People leave their country in search for greater opportunities to reach a fulfilled and happy life. This is an individual decision that may very well depend on personal preferences or particular conditions in the host country. Nonetheless, one could say that when an emigration pattern arises in a country, it’s because lacking proper economic and social conditions. The responsibility of guaranteeing such conditions relies on the governments, whose existence is only justified in promoting the welfare protecting the rights and freedoms of the citizens in their country. Except in cases of internal conflict or war, systematic emigration arises from failed policies sustained by the government.
But contrary to what appropriate governance incentive schemes would require, what the proposition’s plan does is reward governments for ineffective policies with bad outcomes. If a country is poor and doctors start leaving in the search for better conditions, the government would receive a financial boost that would motivate the perpetuation of the failed policies.
The plan simply sets the wrong message. It rewards governments responsible of the lack of resources and opportunities in their countries with money that may perfectly be used in sustaining failed and arbitrary policies.
All this scenarios are very plausible. Since brain drains happen mostly where government have been proven capable of taking irresponsible and bad decisions, it follows that to give them more things to be irresponsible about (reinvesting towards education, not engaging in pressuring people, etc) an ill-conceived idea.
.Economic disparities are inevitable and might arise out of any number of circumstances. The mistake opposition makes here is to characterise poorer countries as poor per se, and to represent the source of their poverty as bad governance.
To take the first point brain drains, including the loss of medical personnel, take place between relatively rich countries provided the income disparity is wide enough. For example, rich Middle Eastern countries actively recruit doctors and nurses from Europe by offering high wages and low rates of taxation.
What about opposition’s claim with regard to genuinely poor countries that their poverty is the result of incompetent or dishonest governance? We find this to be a very unattractive generalisation, what about dearth of resources, adverse climates and so on?
Nevertheless let’s consider the marginal case they postulate on their terms:
“If a country is poor and doctors start leaving in the search for better conditions, the government would receive a financial boost that would motivate the perpetuation of the failed policies”
Allowing these poor countries to benefit from the comparative advantage they do have is a way of granting them a revenue stream which replaces the loss they experience under the status quo advocated by the opposition. It is true that a corrupt government intent on crushing the people and making money for itself could train huge numbers of doctors at 8 years a piece; enforce a network of disincentivising legislation to work domestically, and pocket the money paid back for their training along with the profit. Although this would be a bizarre and inefficient way of making a corrupt dollar, at least it is economically feasible. Surely the chance of this happening, however, is of insufficient significance to outweigh the costs of persevering with the very real and present injustice? (Note, that in this argument, opposition concede our suggested model would result in an increase in revenue to the poorer country, and incentivise governments to train more medical personnel, a fact they elsewhere deny.)
Above all, we ought not to give up the attempt to form policies designed to assist poor countries, on the basis that the source of their poverty is likely to be corrupt government, and therefore to act to alleviate their citizens’ hardship is to offer assistance to corruption. This is a counsel of despair, which, upon mature reflection, we are sure opposition would not wish to endorse.
Plan unduly increases the control of the state over medical personnel
Under proposition’s plan the individuals freedom to leave the country could be harmed if the compensation is to be given prior to departure, because s/he would have to wait at first for the two countries to agree on fair compensation and then during the implementation of the plan for the two countries to make the transaction. If the compensation is to be given after, the enforcement could be on jeopardy, because poorer countries have no way to enforce a payment. And what happens if a country doesn’t want to be compensated but want’s to keep the medical personnel? The mere offering of compensation could drive a country to wake up to the reality of the brain drain and start taking measures to prevent it which could reduce their freedom. Which in turn would do nothing to solve the real causes of the brain drain. In the SQ the issue is complex enough as it is, introducing a new variable for countries will worsen the complexity of the problem. Brain drain already goes unattended by many countries and yet it is but a symptom. Adding another layer will distract the poor countries away from the root cause, therefore it’s wise to leave this situation as it is.
Let us be clear, we are actively seeking to ‘harm’ individuals’ freedom, under very narrow specified circumstances. Namely in the special case where they have been trained as medical personnel at great expense by their home country and intend to promptly work abroad without giving anything back. This is the most damaging form of brain-drain. We are opposed to it and seek to rectify it. We believe this to be an anomalous feature of the status quo, a loophole which must be closed.
Other than in this desirable sense, our plan has no bearing on the relationship between the state and its medical personnel.
Again, opposition are exercised over practical difficulties that do not exist. The cost of training medical personnel is X dollars or shillings or rand. If a nurse or doctor wishes to work abroad on graduation, his new employers must reimburse the cost of this training in advance. There is no need to wait or negotiate, the figures are known and paid in advance, just as happens in countless numbers of such contracts around the world. Rich countries could renege on this commitment as they could with any contract. This arrangement is no more vulnerable to abuse than any other.
‘What happens if a country doesn’t want to be compensated but wants to keep the medical personnel?’ Well, what happens now? The medic says “sayonara”, “aufwiedersehn” or “au revoir”, and the country that trained him gets a postcard.
The next line of reasoning is even more self-defeating. Now the offer of compensation ‘could drive a country to wake up to the reality of the brain drain and start taking measures to prevent it…” Precisely, this is exactly what we want to happen, isn’t it?
This is the essence of the opposition’s dilemma, they seem to have argued themselves into a position that is simultaneously opposed to the brain drain and in favour of the status quo.
Actively recruiting exacerbates brain drain
As the Proposition so kindly expressed “Brain drain is […] an unacceptable form of intellectual colonialism”. This is so Because of the nefarious consequences it has on both the drained countries and the host countries.
In the poorer nations it has the effect of undermining the international aid efforts and making development unsustainable. In Africa the fight against AIDS and other diseases is crippled by the lack of doctors and nurses who have left the countries. It also makes development unsustainable, as the countries are constantly having to train people to satisfy the basic needs of the population and can’t take the next step and develop their own research and development facilities (Finding and producing cures and vaccines). On top of this, brain drain undermines the aid efforts by developed nations, since training programs for doctors and nurses have no lasting effect (the recipients leave instead of having a multiplier effect), the investment in hospitals and medicines can’t be used to its full extent since there aren’t enough people to put them to use. Without a proper and sustained research community (not undermined by brain draining) health-care in developing countries can only attack the short term consequences of illnesses, instead of taking mid to long term efforts on solving these problems from the root.
But the largest effect brain drain has is that of a vicious cycle in which citizens doubt the ability of their country to tackle the main problems, and so they leave for greener pastures. But then when professionals start leaving the country the situation gets worse as basic services such as education, health-care and infrastructure are affected by the ensuing lack of personnel. This further undermines the confidence of the people in the future of the country and then crisis comes as there is a lack of entrepreneurs, managers, teachers, nurses, doctors, engineers, technicians, etc. It is comparable to a bank run, where the lack of confidence of the people lead them to withdraw their savings, and thus the collapse of the bank results from a self fulfilled prophecy.
When a country loses its intelligentsia, then the social and political situation become starker as the population becomes more and more vulnerable to populism and fundamentalism, having their hopes exploited in pursuit of a solution to their current woes. This further alienates an important sector of the population, which starts looking for ways to make a living abroad, creating migratory pressure on more affluent nations, as is the case with African nationals constantly seeking to immigrate to European countries.
The main consequences of exacerbating brain drain for the rich nations would be over-recruiting professionals and migratory pressure. Over recruiting personnel can have analogous effects to those of overfishing: if too many fish are extracted from the swarm, then the reproductive ability of the swarm will be damaged and the fish population will decrease over time, if too many health professionals are recruited then the poorer nation will ultimately start losing professors which will affect the quality and quantity of the health professionals trained in the future, until the amount poorer nation cannot meet its own basic needs nor can it train any more health professionals. At this point the poorer nation is worse off than before, and the rich nation has now lost a provider of medical staff, since they didn’t invest in their own people they can’t meet these demand and so they are now unable to satisfy their health needs by either imports or local production. On the other hand, the migratory pressure can collapse social services, increase the unemployment rate and create inner social pressures due to the exclusion that immigrants often have to suffer, which can generate instability in rich nations (as witnessed in the French riots of 2005).
The plan proposed openly promotes brain draining, for it motivates governments in poor countries to open their doors for doctors to leave, and eliminates the moral incentives of doctors to stay (because they may now think “Hey, the rich country paid for me to leave, I don’t owe anything to my country anymore”). All of the problems of the SQ stated above would simply increase in a world where these types of compensations exist. Since both teams agree that Brain Draining is an undesirable feature in present time, we should both reject the plan as an alternative for the future.
The crux of opposition’s argument here is that our proposal ‘openly promotes brain draining for it motivates governments in poor countries to open their doors for doctors to leave’. Alert readers may notice that this is the opposite argument to the one made above. Then opposition asserted our proposal would have the affect that ‘the individuals freedom to leave the country could be harmed’ and, heaven forbid, this might incentivise governments to take measures to prevent the brain drain which could reduce their citizens’ freedom.
Perhaps we can assist opposition in their confusion. Yes, our proposal would restrict the freedom of newly-graduated medical personnel to cut and run without compensating the home nation for the costs of their training.
And yes, by adding a significant but proportionate cost this will deter richer countries from poaching medical personnel. This is the market working as it should, by recalibrating price upwards we damp down demand and encourage supply; an economic solution to what we maintain is essentially an economic problem.
So, to put opposition out of their misery, their previous answer was correct. Our proposal does not motivate governments to open their doors, as opposition’s own lengthy depiction of the status quo demonstrates: those doors are wide open now. What we suggest places an obstacle, a turnstile if you will, that rebalances the status quo in poorer nations’ favour.
Elsewhere the opposition attest that “the countries are constantly having to train people to satisfy the basic needs of the population and can’t take the next step and develop their own research and development facilities”. We feel that this IS a problem with the Brain Drain, but not with our model. Our model seeks to rectify this exact problem. Currently, under the status quo the opposition proposes, poorer countries are having to foot the bill of the training of medical personnel who then migrate to richer countries, as well as being burdened by the other costs of maintaining a medical infrastructure. The compensation aspect of our model removes the burden of paying for training from which the poorer country derives no benefit. The process of promoting these poorer countries as centres where medical personnel could be trained on a large scale, might even attract foreign investment for the maintenance of hospitals and equipment in poorer countries.
The slippery slope that the opposition perceive can be dismissed easily, as history is riddled with cases where populations have doubted their governments, but we have not seen such mass migration as the opposition suggests.
The opposition provide no explanation of why the doctor or nurse who wishes to relocate has an obligation to the poorer country where they first trained (which the proposition have repeatedly proven does not exist on moral terms only on an economic one).
Plan widens the research and development gap
Differences on latitude have people suffering from flu on winter in the UK when people is affected from Chagas in Venezuela. Sanitary and demographic differences have people suffering from diabetes and coronary failures in the US when people die from Malaria in Africa. There are epidemiological particularities for every country. Each country should actively advocate for structural elimination and cure of the illnesses predominant in their territory as a public health priority.
Underdeveloped countries tend to have a significant deficit on the resources allocated to the health sector, particularly when compared with their developed peers. This lack of resources, parallel to extreme poverty and incapability of the people to finance research by themselves, obligates governments to use most of it advocating for short term priorities. This leaves internal research and development mostly incapable to meet the challenges of the country. [[http://www.scidev.net/en/health/neglected-diseases/]][[http://news.xinhuanet.com/english/2006-03/13/content_4295423.htm]]
The huge differences in medical research budget among developed and developing countries explain why great advancements have been made on curing erectile dysfunction or on coronary failures when poor achievements appear on curing tuberculosis, malaria or AIDS in Africa. [[http://books.google.com/books?id=h25piGXAHukC&dq=erectile+dysfunction+research+funding&source=gbs_navlinks_s]] [[http://www.mrc.ac.uk/Ourresearch/Portfolios/Overview/index.htm#P78_4441]] Attached to research comes literature production and knowledge. Almost all of medical literature and papers have been and are being produced in developed countries. This sets up the agenda for worldwide medical teaching, and in an attempt to keep up to date doctors get biased towards the priorities in developed countries.
All in all, this notion of a group of countries breeding all knowledge and the other only imparting that knowledge is one of the greatest problems in the status quo. This perspective has doctors in underdeveloped countries instructed in how to cure people in developed ones, and prioritizes the appeasing of the underdeveloped health problems, rather than their elimination.
The motion and the counterpart’s plan are both based on this perspective. The proposition views the status quo as a great business opportunity for an industry of creating doctors destined to foreign markets. Promoting medical migration to developed countries would further bias research, because in developing countries medical researchers are the ones that lack opportunities the most. This kind of migration would leave developing countries with much less endogenous research and literature production that can properly advocate for the health problems of the majority of people in the world.
According to a statistics report by the National Science Foundation, a U.S. federal government agency, “Growth in health-related R&D in the 1990s has supported research on cancer and AIDS as well, but a great deal of the new funding has been directed toward other disease areas. … but perhaps part of the growth comes also from the influence of disease-specific lobbying groups”. [[http://nsf.gov/statistics/seind02/c4/c4s1.htm#c4s1l1]]. Here we see how North American health research priorities and funding are greatly influenced by the more than 60 medical special interest groups registered to the National Institutes of Health, which include the “Tobacco and Nicotine special interest group” (did you see Thank you for smoking?) or the “Mouse Club” (which advocates for research on “Murine Molecular Genetics”) [[http://www.nih.gov/sigs/sigs.html]]. In order to meet the 21st. century’s health challenges we must prioritize research on health problems affecting the majority of the people, instead of taking actions such as the counterpart’s plan, which further promote research on the problems of the wealthy.
The misunderstanding here is that whether there was a brain drain or not, there would still be an underfunded medical research sector in a poor country. The fact that a country is described as “poor” indicates it has limited resources to allocate to different purposes. A huge medical research commitment is never going to be approved as a worthwhile use of their limited budget, because in the modern age of globally shared medical information (remember developments in medical technology are not treated in the same way developments in nuclear technology are), an easy cost benefit analysis would rule it would be in the best interest of a poorer country to let a richer country develop the drugs and cures for diseases, whilst the poorer country used its budget towards basic infrastructural needs. The notion that AIDS and tuberculosis would go ignored by the medical research of a richer country is ludicrous. For example, drugs for the treatment of malaria have already been developed, with the ingredients needed for this drug internationally known, the reason why we still see high numbers of malaria cases in African countries is because they are unable to afford the drugs themselves, not because they are deprived of the knowledge of how to develop these drugs.
Plan creates more friction between richer and poorer countries
In the first place, many of the poorer countries will take great offense if the retribution is less than they expect. Specially if that retribution follows a criteria that does not necessarily reflects the quality of the doctor, but instead reflects ideological or political issues. For example, it could happen that a country would try to hire or compensate countries that follow the same ideology or that support them politically. This type of support can increment the important inequalities between countries. We know the proposition may try to argue that other issues such as arms selling and invasions are worst. However, given that we are talking about the exchange of people, tensions can surely flourish easier. Not promoting brain drain actively will avoid unnecessary tensions. Even after the transaction is done, rich countries can breach or change the contract. In that case under-compensation or not compensation at all with will surely increment friction.
Third, most of the poorer countries have not demanded compensation. The proposition can claim that is not a reason to avoid doing their plan or that even if compensations are not popular, they are right. But many governments seem to think that it’s not right to treat citizens as a simple merchandise. Mobilizing people is a sensitive matter. Following this line of thought, It is wrong to promote brain draining because of its pernicious effects. In fact, the main effect of brain draining is lack of growth because countries may lose the most skilled workers or entrepreneurs. In fact, according Nadeem U. Haque and Se-Jik Kim “human capital or brain drain can lead to a permanent reduction in income and growth of the country of emigration to the country of immigration”. [[Haque, Nadeem U. and Se-Jik Kim (1995). Human-Capital Flight – Impact of Migration on Income and Growth. International Monetary Fund Staff Papers 42 (3): pp. 577-607.]] Obviously, fostering brain drain can severely damage the economy of the poorer. Therefore, it can create or increment tensions between the rich and the poor.
As we have repeatedly made clear we abhor the brain drain and at this late stage opposition do not need to lecture us on how bad a thing it is, we know. In fact we think it is so bad that it deserves formal international recognition to actively control it, rather than allow the deadly passive drift to continue.
We have proven that this issue can be reduced to an economic one, such that there really is no political or ideological criteria that would influence the price paid for the resource. Despite having criticized the idea that the state would have any control over flow, opposition have now characterized the exchanges as state orchestrated? To help them out again: it isn’t. The poor country doesn’t choose where doctors will want to emigrate. The rich country compensates the home state of the doctors that choose to apply for work there. There may be some natural affiliation in ideologies in terms of domestic doctors’ preferences, but we fail to see how this is relevant; how this is heightened under our model as opposed to the status quo, or even why it is a particularly harmful thing?
An emergent rhetorical theme here is that the act of paying poorer countries for the cost of training their medical personnel is somehow demeaning, while poaching them for nothing honours their dignity. But paying a fair price for the cost of education and training isn’t to treat humans as simple merchandise, any more than paying them a fair wage is.
Their plan is a failed Economic Model
The concept of demand, according to Arthur Sullivan, is the desire to own something and the ability to pay for it [[Sullivan, arthur; Steven M. Sheffrin, 2003. Economics: Principles in action. Upper Saddle River, New Jersey 07458: Pearson Prentice Hall. pp. 79. ISBN 0-13-063085-3.]]. In this sense, there is the need for a good or service, and there is a capacity to acquire a good or service. In international trade, when the invisible hand arranges incentives for the world to have laptops made in Taiwan, it does so because Taiwan is more efficient at providing the world demand of computers.
Now, maybe I need a laptop for working all day and for debating until dawn, but I have to stick to this Pentium III dinosaur instead. Maybe some Canadian kid just wants a computer to play Monkey Island once in a while, but since his father has the money, he gets him the laptop I wanted. This is a cartoonish depiction of how the Capacity element makes the concepts of Need and Demand so different from each other. The Taiwanese company is centered on satisfying the demand for computers, but not the need of computers. Prop. may say “Needs are based in preferences, and these are not comparable nor can be aggregated, according to Economics Nobel Laureate Kenneth Arrow”. Even when this may be arguable, the fact is that when it comes to health care, the UN has clearly established worldwide priorities in the Millennium Development Goals. These are: reduce child mortality AND maternal mortality in two thirds and reverse the spread of HIV/AIDS, Malaria and other diseases
The areas most affected by these problems are Subsaharan Africa and Southern and Western Asia (Affected as well by poverty, hunger, and all the other elements set as priorities by the UN). [[http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2008/MDG_Report_2008_En.pdf#page=22]] So let us be clear erectile dysfunction is indeed terrible. But according to the consensus of the leaders of all countries the priority of the world efforts should be to solve the health problems that particularly affect the poor areas. And these areas are the priority because they lack of capabilities.
The whole “comparative advantage” of poor countries over rich countries is based in the higher capacity (and therefore, demand) for accessing medical services and everything else in rich countries. It is our case that the mechanism proposed by the proposition would arrange market forces in a negative way that will damage priority health care in poor countries.
First of all, it must be said that demand for health care in developed countries is inelastic. This means that an increase in the price paid will have a very small impact over the quantities demanded of the service. [[http://books.google.com/books?id=rwYSN_QU9gIC&pg=PT183&lpg=PT183&dq=economic+elasticity+medical&source=bl&ots=lTlDE6mIEM&sig=vsrSZWZG-n7pkNVWgUxyuMAKx7k&hl=en&ei=zwGwSua5HaGStgfXqq2yCA&sa=X&oi=book_result&ct=result&resnum=9#v=onepage&q=economic%20elasticity%20medical&f=false]] In this sense, having people in rich countries pay compensation to poorer countries will not significantly decrease their demand for health care, so their demand for foreign doctors would stay pretty much the same. But their system will quickly increase the supply of doctors to rich countries with doctors currently supplying the need in poor countries. This is so because governments in poor countries will seek alleged “profit” by causing further brain drain as explained in our other arguments.This process may leave the poor country with more cash, but this may perfectly translate into worsened health care for the poor.
Training new medical personnel to replace brain drain can not be easily done with money. The fact is that human capital is a scarce resource and it takes a lot of time to produce it. In the case of the medical personnel it takes several years of training and work experience. In the example of Kenya (already mentioned by the other team) it takes 4 years to become a bachelor in Medical Physiology or to get a nursing degree.[[http://www.uonbi.ac.ke/academics/degree-information/?page=Bachelor&id=99]].[[http://www.ku.ac.ke/schools/health/index.php?option=com_content&view=article&id=38:department-of-nursing-sciences&catid=19:departments&Itemid=35]]. To the 4 years we have to add the valuable and needed years of work experience.
All this reveals that investments in improving medical capability and training personnel are long term. Money is not necessarily sufficient to compensate for the time it needs to train medical personnel. On the other hand, for this specific case, the market fails to accommodate immediately. The lag between exporting medical personnel and the training of new personnel is extremely harmful. This lag means that myriad of poor people will not have the same access to health and will feel the consequences of the mechanism. The lack of access to health causes both political instability and economic meltdown.The plan may actually even decrease the production of medical personnel in poor countries. First, exporting medical personnel may export medicine, physiology and nursing professors that would not be there to train the new personnel. Second, lack of health decreases labor productivity and even decreases the accumulation of capital. Health is a factor that encourages economic growth by improving labor productivity and through the accumulation of capital by extending life expectancy.
In a a study done by three Harvard professors their ” main result […] is that health has a positive and statistically significant effect on economic growth. It suggests that a one-year improvement in a population’s life expectancy contributes to an increase of 4% in output” [[http://qcpages.qc.cuny.edu/~redwards/GC-Econ71100/bloom-etal-wd04.pdf]].
The proposition’s plan may severely threatened the capacity of the country to grow which discourages new investments in health and worsens the situation. At the end, the country may enter into a vicious cycle of lack of health followed by lack of grow and so on, just for liquidating a valuable asset: their medical personnel.
It isn’t even sure that this mechanism will increase the health budget, since poor country governments may discretionally use the received income for different means. It may be even worse, because if the system just compensates governments for the amount spent in training doctors, then there wouldn’t even exist a profit.
Proposition sees our assertion that the value of a doctor, includes, amongst other things, the years he would serve, measured in decades and instead of meeting the challenge and including them they insist of including just training.They say” It costs the Kenyan people $66,000 to train a doctor”, they include all education this time and they contrast it [with ] the UK tax payer [that pays] between $300,000 and $375,000 to train a single doctor – between five and six times as much”. But again, no single mention of the lost decades of service. Why? because they know that to really pay the value would render the importing of MPs nonviable. Especially if you consider the already mentioned impact of MPs on the growth of the economy.
Finally, in an economic contradiction, they call for further polarization in the research sector: “an easy cost benefit analysis would rule it would be in the best interest of a poorer country to let a richer country develop the drugs and cures for diseases”. Amazingly, in the same paragraph they state: “The reason why we still see high numbers of malaria cases in African countries is because they are unable to afford the drugs themselves, not because they are deprived of the knowledge of how to develop these drugs”. In any case, they conceded that the plan further pushes R&D to rich nations.Had the poor countries developed the existing drug for malaria, or developed new ones, they could be simply reproducing it at a low cost without having patent suits hovering over their heads, thus saving thousands of lives that are now lost. The rush for the AIDS cure is based in it’s potential profitability, but we know that due to lack of R&D (further promoted by the plan) poor countries (The most affected by AIDS) will not receive any profit, and will be left without the cure, since the patent won’t belong to them.This could be a public health issue for rich countries. It was in Africa where AIDS and Ebola appeared, Mexico where swine flu appeared, and Cambodia where the bird flu appeared. These diseases were only advocated for once they had gained momentum and spread towards rich countries. Stopping potential worldwide endemics that affect us all requires having a well prepared and well funded R&D team in every poor region of the world that can constantly track the development of new diseases, look for it’s cure, and avoid or contain worldwide spreading. [[http://news.bbc.co.uk/2/hi/americas/8016909.stm]] [[http://news.bbc.co.uk/2/hi/asia-pacific/3429851.stm]] [[http://www.avert.org/origin-aids-hiv.htm]] [[http://virus.stanford.edu/filo/eboz.html]]
In conclusion, their plan focuses in meeting the demand of health care rather than the need of health care. This approach will very counterproductive in terms of the world’s health care priorities, since it will most likely increase Brain Draining from poor countries in the short run (perpetuating the inefficiencies and problems previously stated in our case through inelastic demand in rich countries and governments promoting migration in the supply side), and reduce the poor countries capacity to produce doctors in the long run.
In attempting to criticise our model, Opps get off on the wrong foot by stating that the comparative advantage poorer countries enjoy results from ‘the higher capacity (and therefore demand) for accessing medical services and everything else in rich countries.’
This isn’t the cause of the comparative trading advantage at all. Poorer countries have a comparative advantage because of lower local costs, as demonstrated above in the case of Kenya, where the cost of training a doctor was 1/6th of the cost of doing so in the UK. Of course remunerations are proportionately higher in richer countries, hence the conditions for the medical brain drain.
Opps go on to say that increasing the cost of recruiting doctors from poorer countries won’t decrease demand for foreign doctors because demand for health care is inelastic. But this is to confuse the healthcare provider’s demand for capacity with the patient’s demand for treatment. If a hospital or health service is faced with two similarly qualified candidates, but the decision to hire one would require them to reimburse the cost of their training, it’s obvious this would weigh in favour of the locally trained physician and reduce the attractiveness of the foreign option. Again, we reiterate, this is an inviolable law of the market, and it’s why our suggestion cannot fail but to reduce the brain drain.
That medical problems are most severe in SubSaharan Africa; that the priorities of medical research are seriously out of step with the needs of poorer countries, all these ills of the status quo we accept. But since the Opposition endorses the status quo it merely does their case a disservice to continue to quote them.
The same is true of all their arguments about the domestic consequences of the brain drain; lead times in training new staff; skewed priorities in research and development, all these failures are failures of the status quo which they endorse and we oppose. For this reason, all the energy their pour into describing the pernicious effects of the medical brain drain; its negative impact on wider economic development and so on, serve our cause and undermine theirs.
Opps then repeat the claim that even if donor countries were reimbursed for training medical personnel, this money would not necessarily be invested in health care. Again we say, however, that this is a great advance on the status quo, where poorer countries lose both the investment and the medical personnel it helped to create. As they put it, training medical personnel cannot be done easily with money, but it cannot be done at all without it.
They also reheat their argument that the problem with our plan is not that we are offering to reimburse donor countries for their training of doctors, but that we are not offering them enough. Our answer is the same. A. Some restitution is better than none, and B. Where the brain drain is greatest, the potential for gain is greatest also. A newly graduated doctor in in India earns a basic salary of $160 a month, no wonder India exports more doctors than any other nation, over 40,000 work in the US alone, while a full 10% of UK doctors were trained in Indian medical schools. [http://content.nejm.org/cgi/reprint/353/17/1810.pdf]
In the first place our suggestion would greatly reduce this number as shown ad nauseam, in the second, what medical personnel were still able to find work abroad would not represent a pure loss to the Indian economy, as now.
We are not attracted to the idea of seeking to put a figure on the wider economic impact of the emigration of medical personnel, for the simple reason that if the proposed reimbursement becomes so high as to be a de facto embargo, then we would simply be lapsing into the already rejected protectionist model by default.
It is only by pitching the cost of importing foreign trained doctors at a figure that represents value to both parties in the exchange (and is an unequivocal improvement over the status quo in poorer nations) that we are able to sanction the active recruitment of doctors and nurses by richer countries from poorer ones.
Again we would give the example of the Phillipinnes, where even an informal adoption of our economic model resulted in a massive 10% increase in total national income. ‘Failed economic model’ indeed.
Welcome to the third world
Ah, the joy of not living the reality of the Third World, how we envy the proposition! We intend to guide the readers into the real facts and situations during history, and which continue to occur at the very moment of this debate, regarding: governance, poverty, corruption and rights of the individual in developing countries.
What are governments capable of? The opposition said: “the governments are hardly going to force medical personnel out of the country to ship them off for profit”. Governments don’t always care first about the welfare of the population. Their priority is to maintain themselves in power in order to exercise it for the profit of the ruling elite. Case in point: of 22.000 employees, the most prepared and capable of Venezuelans Oil Company (PDVSA), and Venezuela’s president Chávez who fired them, some by name, on live TV, just for their political ideologies[[http://articles.latimes.com/2002/dec/23/world/fg-briefs23.1. Today the company can’t produce even half of what it did before. In Turkmenistan the government decided to close all hospitals that weren’t in the cities, and started “replacing up to 15,000 doctors and nurses with unqualified military conscripts”. [http://www.foreignpolicy.com/articles/2009/07/22/the_list_the_world_s_worst_healthcare_reforms?page=full]] On the right side of the bus, you can see the third world.
Still prop. side has faith. They say “We have proven that this issue can be reduced to an economic one such as that there is really no political or ideological criteria that would influence the price paid for the resource”. Desperation can lead to a lower compensation, political alliances, like the one between Cuba and Venezuela can lead to subsidies[[http://www.bnamericas.com/news/oilandgas/Analyst:_Govt_Loses_US*2,62bn_in_Oil_Subsidies_to_Cuba]], and political differences can lead to halt in economic ties and trade as the case between Colombia and Venezuela[[http://news.bbc.co.uk/2/hi/americas/4268619.stm]][[http://www.cnn.com/2007/WORLD/americas/11/28/venezuela.colombia/index.html]][[http://www.cnn.com/2007/WORLD/americas/11/28/venezuela.colombia/index.html]]. The prop. couldn’t see how Actively recruiting will exacerbate brain drain. They find that posed the following contradiction: either poor government open their door for BD or increase controls. There is one more option, that the ruler can open the doors to MP that want and also selectively choosing who leaves, when and for how much.
They [also] fail to see the relationship between bad governance and poverty. They argue that “The mistake opposition makes here is […] to represent the source of their poverty as bad governance”. We don’t claim poverty is necessarily a consequence of bad governance but rich countries rarely have it, if a rich country gets bad governance, which includes bad administration of the state resources, it could loose its riches. There is the direct link between bad governance and people migrating, now, if you add the plan of the proposition that incentives the brain drain, the situation will worsen because of a further deficit, as we explained in our 4th argument. The Proposition correlates dearth of resources and adverse climate to poverty. However, empirical evidence like earthquake-prone Japan, the Western countries that have bitter winters, Oil-deprived Israel and UAE, etc. vs tropical and resource abundant Africa and Latin America suggests the opposite correlation (adverse climate and scarcity of resources paired with economic success), we however don’t think climate is a relevant factor to consider in this debate.
They say that it is “feasible but marginal” that countries will deviate resources into other things rather than medical training because of the lack of transparency. They also claim that we agree that their plan is a source of revenue. First, revenue doesn’t necessarily means profitability and less when they always express the transaction in terms of the cost as opposed to in terms of the value, it’s not profitable to liquidate and asset for its cost because no profit is being made. Second, even if it was marginal, we are alarmed that the proposition thinks it’s OK to give money to a corrupt government; but it is actually not marginal, but rather the norm. They asked us to make a mature reflection on abandoning poor countries on the basis that they have corrupt government, but if they care so much about the people and the rights of the individual, how will they ensure the poorer government will invest that money to satisfy its citizens’ needs? History shows that the ruling elite is the one that perceives the benefits of the income, so it is definitely better to have the medical personnel that is already there than its corruption-vulnerable monetary equivalent. Besides, since a correlation can be preceived between transparency and GDP per capita[[http://manyeyes.alphaworks.ibm.com/manyeyes/visualizations/corruption-vs-gdp-per-capita]], transferring resources from richer to poorer nations roughly amounts to transferring resources from less corrupt to more corrupt countries, thus the plan increases the amount of money falling prey to corruption and hence makes the world economy less efficient.
They blame us of been trapped in a dilemma “that is simultaneously opposed to the brain drain and in favor of the status quo”. Yes, we don’t think the DB is good but no, we aren’t really in favor of the SQ, it’s just that we prefer it to the proposition plan, because it will worsen an already bad situation and wont solve the problem. Precisely because we know how individual rights are blasted in Third World countries, our main value, above all, is freedom. Yes to stopping brain drain but NOT at the cost of freedom. The real dilemma is on proposition’s side, when they say that “brain drain is unacceptable” but they’re willing to pay for it. As if money made things right, people who think drugs or prostitution are unacceptable aren’t the ones advocating to create a legal market for it. They say that BD is an “anomalous feature from the status quo a loophole that must be closed”… that’s a weird thing to say for a team that supports actively recruiting talent away from poorer countries. On the same point, their rebuttal to no point 3, they carelessly intended to quote us as saying, “now the offer of compensation could drive a country to wake up to the reality of brain drain and start taking measures to prevent it”, but they forgot (or did they?) to add:¨”which could reduce their freedom. Which in turn would do nothing to solve the real causes of the brain drain”. It is not about taking random measures and reducing freedom, but rather tackling the root causes that lead people to leave their country. It is very dangerous and sadly ironic to provide a way for repressive inefficient governments to remain in power using the resources obtained from cashing in on their political expatriates
We showed a link between brain drain and ever growing populism, instability and fundamentalism. Prop. wanted to get this “dismissed easily, as history is riddled with cases where populations have doubted their governments, but we have not been such mass migration as the opposition suggested”. Sure, except for the Cuban exodus to the US, USSR migration to the West, African legal and illegal immigration to Europe, the Irish emigration, and the people flocking from East Germany to West Germany. All countries where BD deepened and then populism, instability and fundamentalism grew. In any case they are deforming our argument because we say that BD and populism feed of each other.
The issue of the Third World and medicines and pharmaceutic patents has been dealt with in our 7th argument.
Welcome to the third world, you might want to return home soon or as us, get used to it.
This might be a good moment to look at the actual breakdown of countries most affected by the medical brain drain. As mentioned by far the biggest exporting countries are India, followed by the Phillipinnes and Pakistan. Of the top twenty donor countries contributing physicians to the US, only one (Nigeria) is from SubSaharan Africa, contributing less than 0.3% of the US total. The figures overall are much lower for Australia and Canada, but again South Africa is the only SubSaharan nation to make it onto the list. Furthermore none of these countries can be classified ‘failed states’ or subject to the kinds of extreme abuse of their citizens so colourfully identified by the opposition as the reason for their flight. The full list is published here: [http://content.nejm.org/cgi/reprint/353/17/1810.pdf]
In reality, therefore, the primary cause of the medical brain drain is not, as the Opposition continue to assert, motivated by desperation, fear, extremes of poverty, crime or corruption, it is the mundane economic migration of Indians, Filippinos, Poles and Mexicans, Egyptians and Italians, looking to maximise their earning potential, rather than fleeing some despotic tyrannical regime.
In practice, therefore compensating these countries for the cost of training doctors and nurses runs no risk of sponsoring corruption of the kind the Opp’s febrile imaginations envisage.
However, we would be prepared to run this risk, even if the donor countries were as the Opps imagine them to be, because we fundamentally disagree with their assertion that ‘since a correlation can be perceived between transparency and GDP per capita, transferring resources from richer to poorer nations roughly amounts to transferring resources from less corrupt to more corrupt countries…’ What would they have us do, then, transfer resources from poorer to richer?
Opps next assertion is the pivot upon which, in our view, this entire debate turns:
‘There is the direct link between bad governance and people migrating, now, if you add the plan of the proposition that incentives the brain drain, the situation will worsen because of a further deficit, as we explained in our 4th argument.’
As the facts quoted above demonstrated the characteristic feature of the main donor nations in the medical brain drain is not bad governance, these are, in the main, mature democracies and stable sovereign states. Leaving this aside we now turn to the substance of the Opps entire case: that as they put it our plan ‘incentives the brain drain..’ ‘… as we explained in our 4th argument.’
We went back to Opps 4th ‘argument’, and we have to say that the most persuasive thing about it is the assertion in the title (that our model ‘exacerbates the brain drain’).
But, of the 726 words dedicated to this issue, only 43 (contained in the penultimate paragraph) even address this subject at all. Here they are:
Our model… ‘motivates governments in poor countries to open their doors for doctors to leave, and eliminates the moral incentives of doctors to stay (because they may now think “Hey, the rich country paid for me to leave, I don’t owe anything to my country anymore”).
As we’ve said, in the status quo the door to doctors and nurses leaving is already wide open, that is the problem, you can’t open a door twice, so our model has no bearing here. (Except, of course, in the Opps imaginary scenario where corrupt dictators force their medical trainees out of the country for the cash they elsewhere depict as derisory. We are prepared to live with this risk.)
So, in effect, their entire argument boils down to the notion that requiring richer countries to compensate poorer ones for the cost of training medical personnel they recruit, ‘eliminates the moral incentives of doctors to stay…’
Even if this were true, and it doesn’t give these fledgling medics a great deal of credit, but even if it were true that some less committed graduates would abandon their intentions to help the sick of their own countries simply on this account, this is only half of the equation – the supply half. But there are already more foreign doctors from poorer countries applying for training posts than there are vacancies in richer countries. In the UK, for example, there were three applicants for every training post and 20 for more desirable specialties such as surgery. [The Times, Feb 7, 2008]
This is the reality of the labour market for medical personnel as things stand. When the British Government, after years of encouraging foreign medical graduates to apply for jobs in the UK through the Highly Skilled Migrants Programme, found it had more doctors than jobs, it attempted to rescind this legislation in order to protect the prospects of UK trained doctors. Who do you imagine challenged this move? The British Association of Physicians of Indian Origin, which argued (and won) in the courts for the rights of their physicians to work in the UK.
These kinds of lurches from glut to shortage, from putting up tarrifs to creating incentives, are symptoms of market inefficiency crying out for exactlythe solution we advocate.
Harms and more harms
How do you know which country is richer? And does it matter which is the richer country? Going by the prop’s own definition of BD as unacceptable, the answer would be no. If taking away a brain from another country that needs it is unacceptable, it shouldn’t be acceptable if the country isn’t the poorest or even poor. Doctors are a scarce resource and are needed everywhere. So why wouldn’t all countries claim they need compensation? Do you need a doctor or nurse any less because you live in Europe? Many countries could ask for compensation if this is implemented as explained, they would only need to show that they are poorer than another where their people are migrating to. This would greatly complicate relations between countries.
The prop. plan has all the potential to work as the intellectual colonialism they try to avoid. In this unilateral approach the richer country could offer the compensation that it determines as just for taking what it wants. This could bring some former Colonies very bad memories of olden times and create some friction. The poorer government doesn’t decide the price because as they explain, if the poor country doesn’t accept the compensation because it doesn’t like the number or is offended by the compensation, the the doctor can leave (and send the postcard) and the rich country gives the money undermining the decision of the poor country. Not to mention the fact that, to get an idea of a real amount to offer the rich country would have to go into the poorer country’s business to know data to base an offer on. This is both asymmetric and imperialistic. We blush just imagining the epithets Obama would get from Chavez if the first offered to pay Venezuela for all the MP that have migrated there, and how fast he would not only decry this offer as offensive while threatening to call his ambassador back from Washington, but offer to pay the heating costs for half a state in the US just to show off. Oh no, we are sorry, he already does that last thing. Well, he would find something.
They say “…brain drains, including the loss of medical personnel, take place between relatively rich countries provided the income disparity is wide enough. For example, rich Middle Eastern countries actively recruit doctors and nurses from Europe by offering high wages and low rates of taxation”. This example is given as proof that BDs have economical causes and the situation in the country doesn’t play any role, but we didn’t say that this phenomenon is only caused by any one cause. There are some brain drains explained by improvements on salaries, as the example of Saudi Arabia and Europe. What we say is that there are other causes for BDs. Upon closer viewing, their example shows people take into account more than money. Contracts for MPs in Saudi Arabia last one or two years. To understand why so little we only needed to look at the answer to the question “Can I take my family? (“For nurses no, the contracts are single status”) to know why. And it’s single female nurses since, as its explained,”there are very limited posts for male nurses as Saudi Arabia is a Islamic society and males cannot nurse females or children on their own, there should be a female present.” [[http://www.nursinginsaudi.net/FAQs-FAQ–Working-as-a-nurse-in-Saudi-Arabia]] Of course people would leave Europe for Saudi Arabia for a year or two, maybe extend it if you are single. You can see it as a short adventure where you will see the world and make more money. But this is not comparable to leaving your country forever, many times without your family and being bound to this new country in a draconian contract where you have to pay to leave. You come to a decision to leave when you balance what you will gain in money and life style with what you would loose in life style and nearness with loved ones. Most people wont leave Europe for Saudi Arabia forever if they can’t take their children. And there is no money you can pay any one of us in team Venezuela to leave our (albeit hypothetical) children since we all feel we have enough to eat and to live a reasonably comfortable life here. But if we were to be able to take our children with us we may leave. We may stay in the current state of affairs, but anyone of us would leave if political persecution gets a lot worse and makes life here unbearable. That would be crossing our threshold and we would escape to save our lives, maybe leaving dear ones here.
They inquire about our explanation of why “the doctor or nurse who wishes to relocate has an obligation to the poorer country where they first trained (which the proposition have repeatedly proven does not exist on moral terms only on an economic one).” We don’t say they have an moral obligation, we observe they may be patriotic or otherwise attached to their environment and feel that they can use their knowledge to help their country and may feel an obligation. Said feeling might dissipate if they see that their government is getting money out of them. This consideration alone increases Brain Drain.
We agree that brain drains in any direction are bad. It’s just that commercial logic dictates the flow takes place from poorer to richer rather than the other way around. And, as we demonstrated in our previous rebuttal, doctors are not a scarce resource everywhere. The inefficiencies of the present labour market have led to massive over-supply in the UK as we saw.
By persisting in styling donor countries as poor per se and domestic conditions as desperate, they misrepresent the reality of the problem and misdiagnose the solution accordingly.
Although they now attempt to row away from this when they concede, as they must, that ‘some brain drains (are) explained by improvements in salaries’, in their initial point they argued strongly against this by saying brain drains are caused by wars and rampant criminality, and that for this reason compensation would not have any impact.
We see resurfacing here, also, the curious pschizophrenia that characterises their case against compensation as being simultaneously so demeaning and humiliating that no self-respecting Government would accept it, and so dazzlingly beguilingly attractive that Governments would kick their unwilling doctors out just to get their hands on it.
Plan is a huge setback in human rights
The Proposition was quick and honest to acknowledge that their “proposal would restrict the freedom of newly-graduated medical personnel to cut and run without compensating the home nation for the costs of their training”, and then they “If the employee changes their mind and wants to change careers they simply buy themselves out of the contract by reimbursing their employer. If they do so after a year or two, they repay a proportion pro rata. Once they have ‘worked off’ the cost of the investment they become free agents”. It is in their second turn or speech that the troubling view of the Proposition on how to enforce their scheme came to light and so its tragic implications.
What they are basically advocating is that medical education should not be provided for free anymore -and instead generate some sort of debt or obligation- in developing and even in developed nations (from the Philippines to England). It would no longer be free if it comes with strings attached, medical staff are supposed to pay for their education by working their debt off or else pay for the remaining of their contract. Their system is an perverse and degenerate implementation of only allowing student loans for students of medical professions, since at least under a student loan scheme students know how much debt they are acquiring, and interest rates are regulated, these debts are even subject to bankruptcy law in some jurisdictions, the state acts as a guarantor of citizens rights against banks, but the efficiency of government funding is lost due to the cut the banks take for themselves, students however are free to emigrate or switch professions and jobs, provided they pay their loans with their new job or from their new location. There is a reason states choose to provide free education and it’s that charging tuition fees, as a Scottish Education Minister once said, “[prevents] young people from poor backgrounds going on to university for fear of getting into debt”[[http://www.telegraph.co.uk/news/uknews/1554455/Scotland-to-abolish-student-fees-despite-debts.html]].
On the other hand under the Prop. scheme the burden of the contract would be placed upon the students, who are much more vulnerable than the state, the universities and the employers, since they have fewer monetary resources and thus access to legal counsel. The medical professionals will be “[subjugated] to a controlling person or force”[[http://www.merriam-webster.com/dictionary/bondage]] in this case their government, so that they are “obliged by contract to work for a stated number of years”[[http://www.msa.md.gov/msa/refserv/html/servant.html]], and are somewhat “bound to the land” as if they were owned by the state (not too many feudal lords left)[[http://wordnetweb.princeton.edu/perl/webwn?s=serf]]. In colonial times people became indentured servants in exchange for a trade and a passage to the Americas or other colonies, and nowadays they propose to rescue this unfree labor practice, adapting it so people would be doing it for a career in medicine and an air ticket to the West instead. Just as people in debt bondage, indentured servants and slaves, they could be sold to new masters (in this case either countries or employers). The only way out of this brutal oppression is for the medical personnel to buy themselves out of the contract, a right they could hardly have been denied since even slaves were allowed to buy their own freedom.
They finally deigned to clarify whether the compensation was paid to the home country before or after the personnel left the country by saying “his new employers must reimburse the cost of this training in advance”. The thing is, enforcing these contracts means that the home and host countries have to be able to restrict the medical staff from leaving. Else they have no guarantee of compensation once they leave since sanctioning, embargoing or invading a richer nation seldom makes sense, and a medicine professional running off to a poorer country would be free -as a slave who escaped from the US South to a Northern state- because there would be no compensation to work off any more (since the Prop. plan is not a general migration compensation scheme, but rather a richer country compensates poorer country scheme).
If no such measures are implemented then workers would just migrate as they do in the SQ and the plan would not make any significant difference whatsoever, except for driving immigration to a black market where the rule of law would be non-existent and migrants would be have to turn to smugglers and human traffickers to reach their dreamed destinations, and then suffer the hardships of being illegal aliens, and they would also be able to send less money back home, because of their immigration status. No root causes of Brain Drain solved, worst conditions for migrants, less remittance money (that does reach the population, unlike the corruption-vulnerable compensation): All pain and no gain without ensuring enforcement.
However, these draconian measures go against the Declaration of Human Rights[[http://www.un.org/en/documents/udhr/index.shtml]],
Article 4. No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.
Article 13.2 “Everyone has the right to leave any country, including his own, and to return to his country”,
Article 23.1 “Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment”.
The Proposition scheme amounts to servitude, and so it is a violation of human rights no matter if the contracts are enforced or not. Putting a price tag on the right to leave the country that currently holds the contract, switching jobs, careers or just quitting equals the suspension of these human rights, and thus of human dignity. Ensuring enforcement of this plan is a way to try to solve “unfairness” by suspending human rights, an oxymoron and harm like no other.
Our suggestion has no bearing on human rights. Contracts of the kind we advocate are part and parcel of civil law all over the world. Without them, as we showed, employers would not be able to offer educational grants to their employees. When an employee accepts these terms of his employment, to hold him or her to those terms is not an infringement of their liberty. Else all employment would be slavery.
Let’s begin with an overview of the debate and see how things fared. First of all we’d like to bring to attention the lack of adherence to the motion by Team England. The motion required of them to defend that rich nations should actively recruit medical personnel (MP); instead they came up with a scheme where rich countries should compensate poorer countries for the lost medical staff, as if the motion were about fairness rather than about being active or passive. Had they engaged with their motion and provided the advantages of brain drain (BD) or the reasons why is it OK for rich countries to recruit talented professionals, to the point rich countries should instigate it (active), the debate would have been far more interesting. They end up saying things like: “[Brain Drain] is so bad that it deserves formal international recognition to actively control it”, which means BD is so bad it needs to be put under control and not that rich nations should be doing it actively. We called their attention on this topicality breach in the rebuttals to their 1st and 5th arguments, and then in our 8th argument, but as of yet they haven’t picked up the glove.
As for style, we believe that misrepresenting our arguments using incomplete quotes -as denounced in our 8th argument- doesn’t improve the quality of the debate at all. On the other hand their case-wide Moving Target fallacy wasn’t that constructive, either: launching an extremely broad plan meant that we had to refute hypothetical scenarios since their first speech didn’t clarify whether payment was before migration or to compensate past migrations; or what happens if the employee decides to leave the rich nation; or the criteria to determine what country is richer (GDP, GDP per capita, PPP, etc); or if their scheme also applies to those who graduate from private universities, or through student loans, or if it is retroactive or applies to future graduates. Then after we made our guesses and objections they could have engaged our different scenarios and explained how their general approach works in each of them, instead they refined their plan saying things like “If the employee changes their mind and wants to change careers they simply buy themselves out of the contract by reimbursing their employer. If they do so after a year or two, they repay a proportion pro rata. Once they have ‘worked off’ the cost of the investment they become free agents”, which redefines their initial doctors-as-resources approach where rich nations were pouching them, to a doctors-as-the-primary-agents-of-BD one where they have an obligation to their fatherland. Then they attempt to redefine the scope from all MP to “newly-graduated medical personnel to cut and run without compensating the home nation for the costs of their training”. But no matter how much they moved their target with these (and others) unacceptable shift in their framework, we have still managed to hit a Bulls-eye in this debate.
Their Plan, even with their shift in framework and extemporaneous explanations and mechanisms, failed to provide enough details to be acceptable. For instance what does the compensation cover? The costs of College Education? the costs of their entire education? the costs of the public investment made in that person so far (health, security, etc)? or -as we proposed- the actual value of having a doctor in the home country? Since “there is no need to wait or negotiate”, there is no mechanism to add a profit to the compensation. If only the costs are covered, the value of having a doctor at home for 30 years and the increase in economic growth it would cause are lost. Hence it’s a bad business to the home nation, that has no added investment capacity and is running out of its scarce human resource. Also, who pays for the foreign doctors anyway? They have said it is the host country, the employee and also that it is the employer. The thing is the employer for doctors and nurses need not be the state, so in the case of private institutions it is not clear how this would work, are taxpayers forced to subsidize private institutions hirings? Or are private institutions supposed to enter into treaties and negotiations with foreign nations in order to hire employees? Would medical staff be ultimately liable (could they loose their house or go to jail) if their own government doesn’t receive a satisfactory compensation from a foreign government or employer? Would medical staff have to repay their governments in order to work in their own national private sector? Much meaningful debate is lost because of this ambiguities.
The best way to meter the quality of the World View of a team is seeing how able are they to keep a consistent line of thought throughout their case. When they talk about values- as in a point “The Rights of the Individual”- they ridicule, reject and call absurd the notion that “A practical need […] has the power to override the freedom of individuals”. So here they put freedom above utilitarianism. Then they say “…our[Prop] proposal would restrict the freedom of newly-graduated medical personnel to cut and run without compensating the home nation for the costs of their training”. Here they’re saying it’s OK to restrict their individual freedoms due to the practical need of states to either provide health care or train more doctors. So which way is it? Why would they dedicate an entire point to enshrine individual freedoms in their opening speech and also propose a plan that curtails them? Let’s try to ascertain who is the responsible party in BD from their statements: First they say “But with this freedom [to hire workers] would come the responsibility to ensure poor countries were fully reimbursed for the costs of their education”, complemented with how they will address the “pretence[sic] of rich countries that the resulting damage done to donor nations is not their responsibility” but they contradict themselves with “The primary agents are the doctors themselves, so the rich state that benefits has done nothing wrong, and there are no grounds on which they could be made to pay compensation”. Which way is it? Whose responsibility is it then? The doctors’ or the rich countries’? Why would rich countries have to “ensure poor countries were fully reimbursed” by paying a compensation if “there are no grounds” to make them do it? The left hand needs to talk to right hand more often.
They also fail to meet the burden of proof required by their plan, that is:
1. Rich countries are responsible for the BD on poorer countries
2. The compensation corrects BD by either discouraging or by offsetting the loss of the doctor.
They did not prove that rich countries were responsible for the harms of BD, they just asserted both that they needed to take responsibility and that it wasn’t their responsibility. But they fail to say why it has to be them. If it were because they are the ones reaping the benefits, then it makes no sense to make it unidirectional from rich to poor, when all nations could compensate each other for migrant workers without needing to check who’s richer. If it were because they can afford it and because poorer nations need it, then why not the UN or the WHO, or the World Bank or the IMF or any other well funded aid-oriented organization? Also they merely claimed without proving that the demand would diminish due to the increased cost caused by the compensation (refuted by us since health care demand is inelastic), and since they only talk about costs and never the value of having a doctor, then their burden of proof is not met.
Even if the other side failed to analyze who is responsible, let us see, shall we? Lets consider the MP. Isn’t it true that s/he decided to study a medical career under the understanding she would have to give back to the community? Shouldn’t s/he pay it back to be able to leave? No. The MP got the education for free, which means nothing is owed. The plan would make the MP be indebted after the fact, after s/he entered training that was supposed to be free. We don’t have any problem with the student receiving a loan from the government, as long as the MP knows all the implications. But a person shouldn’t be able to sign a contract of the kind the prop. describes, since it violates the signer’s human rights: it constitutes servitude (indenture servant) as the person can’t decide it’s way of life while under the contract unless they buy themselves out of it, and can even be traded. The employer is merely interested in providing health care for those who seek it, solving complex political, economic and social problems of foreign poorer nations is outside of their scope. As for the rich country, their duty is assuring that their citizens have a decent standard of living which includes access to health care. If MPs come knocking on their doors fleeing from harsh conditions and persecutions, why shouldn’t they offer the MPs some hospitality? Even the Proposition acknowledges at one point that they have no responsibility in this. We contest the main party responsible in the BD phenomenon are the home nations, since they are the ones that are failing to provide their citizens with living conditions that are good enough for them to stay. Home nations are the ones with failed economic policies, political instability, fundamentalism and civil strife. Giving them more scapegoats like having Mugabe now declaring that Zimbabwe is in crisis because the West isn’t giving enough money as compensations would mean giving them more excuses to avoid taking responsibility, and thus pushing a real solution farther away.
SQ is not good but it’s preferable to plan because the plan creates new problems. We have established in their argument #6 how implementing this plan would create friction between states and citizens. Firstly, this kind of international transaction is many times ridden with sources for conflict: it could offend nationalistic states if they feel under payed, for example. Added to that it could create friction if a country decides not to let out someone that invented a new technique because to compensate him would take a hundred times more than what it cost to train him. Secondly, the plan could create a need for each citizens to have to prove they are not a doctor, before you can leave the country. Lastly the plan opens a can of worms, tells rulers there is a new tool to be used for power and money and they might use it badly or they may think the way to resolve it is closing its borders: as we say on our no point #3 and then there could be the emergence of a black market as happens with most things that are demanded and at difficult reach. But it also creates problems of perception that are crucial to the future of those countries: Gives the responsible party (the poor country) the position of wronged party since it’s getting compensation. So it reinforces its self perception of being a helpless victim and this takes it farther from solving the problems that cause BD in the first place. Another terrible perception the plan brings is that countries can be compensated by getting back the money they invest on training. Countries should look at their MPs and other brains as more valuable than just their training so the country can improve their situation and make them be comfortable and happy where they are. But the worst of harms created by introducing the compensation model it would be the lost of individual freedoms as we explained in arg. #10. The plan incentives poor governments to restrain freedoms of their citizens since the payment is to be done before the doctor leaves as to be enforceable, governments could be seeing their medical personnel as property or currency. But also the mechanism diminishes freedom when proposing a form of contract that if dissolved has doctor’s paying for it, a form of servitude. Another problem that plan creates, different than further BD, is that there will be less inclined to studding medicine because now it engenders a debt if they want to migrate.
The prop said that BD is “unacceptable” and they “are opposed to it and seek to rectify it. We believe this to be an anomalous feature of the SQ, a loophole which must be closed” therefore, they are trying to solve the BD issue with their plan but they don’t make it
First of all, it’s very likely the compensation wouldn’t end the way the rich country wanted it to be, in the training of new doctors since some of these countries are less than transparent.
Second of all, people leave their country not only because of an increase in wages or tax breaks, which is how the prop. explains BD. We say that a BD happens many times when there is a problem that makes the citizens feel better leaving their situation than staying in it. These considerations are extremely complex and vary with each and every person. They decide about leaving a country considering what they are attached to-if at all: a family, job, friends, house and they add (or subtract) the attractiveness of the country they live in. The attractiveness may vary because of political situation, persecution, inestability, judicial impunity, crime, weather, cost of living. Most of these things are the responsibility of the government. Good governance, as we have shown, can make the country more or less attractive. Few people would go to a war zone just for better wages which illustrates that the context of the country is as important as wages.
The BD is not diminished by the plan. The prop. suggested the compensation would create a price hike that would affect the demand. We showed that the demand is inelastic and it won’t be smaller as demonstrated on our 7th argument.
Lastly we present the question of the Opportunity costs. The investment the State made on the doctor’s public education was made because he was supposed to provide health-care. The real cost is not only the cost of his training but also the cost that he wont be there to help society. In the meantime, the state renounced to other projects just to afford the investment made on him.
Makes BD and union problems worse:
The proposed plan will make the BD worse. First, as we explain in our second point, it gives incentives to governments to solve liquidity problems by “selling their assets”. They may resort to pressuring MPs if not enough of them want to leave on their own. They conceded that this could happen but it would be marginal. We gave to examples of what rulers are ready to do in other to get what they want. So this rise in BD will be caused by the offering of compensation. The ruler might “sell” the MP that teaches other MPs and with this it’s more difficult to create new personnel. The plan of compensation puts the money on the hand of the government and many poorer countries have a total lack of transparency and huge corruption, so the plan would change one doctor ready to cure people for money that could go into the pocket of the ruler. This in turn would deepen the deficit of doctors, not because BD but due to lack of funding of training facilities needed to make up for “sold” doctor or nurse.
There is a problem that would get worse as more foreign MP get drained out of their countries: it will worsen the bargaining power for unions as discussed. They didn’t respond to this argument, discussed as well in our second point so they conceded that more BD would cause problems not only for the poorer country but for the recipient country as well.
In conclusion, we win this debate because we proved the status quo is preferable to their plan. The other team losses the debate because they accept a problem (brain drain) and then don’t solve it, but rather worsen it and then add new problems to the SQ. They lost the debate because they didn’t manage to meet the burden of proof of their plan: that it had the responsible for the damage reimburse the innocent party. We showed that the poor country wasn’t without blame and that the origin of the problem couldn’t be solved by the rich country. And even if they had proved that there are reasons to pay a compensation, they propose a plan that violates human rights and puts the poorer countries’ health, economy and stability at risk.