WEBVTT - Airline Mergers and Health Worker Concerns 0:00:01.280 --> 0:00:05.119 You're listening to the Bloomberg Opinion podcast count US Saturdays 0:00:05.120 --> 0:00:08.280 at one in seven pm Eastern on Bloomberg dot Com, 0:00:08.320 --> 0:00:11.479 the iHeartRadio app and the Bloomberg Business App, or listen 0:00:11.520 --> 0:00:13.760 on demand wherever you get your podcasts. 0:00:15.880 --> 0:00:19.680 Welcome to Bloomberg Opinion. I'm Amy Morris. This week we'll 0:00:19.720 --> 0:00:23.240 look at the medical profession and why so many people 0:00:23.280 --> 0:00:26.360 are leaving. First, we take a look at the US 0:00:26.480 --> 0:00:30.200 nursing shortage and how an untapped resource could help relieve 0:00:30.320 --> 0:00:34.400 some pressure within the nursing industry. Then we'll shift to 0:00:34.479 --> 0:00:37.920 the doctor shortage in the UK. Why they're leaving the 0:00:37.960 --> 0:00:41.400 profession or at least leaving the country to practice elsewhere. 0:00:41.760 --> 0:00:44.320 Why is it so hard to be a doctor in 0:00:44.360 --> 0:00:47.680 the United Kingdom? Speaking of leaving your profession, we'll also 0:00:47.800 --> 0:00:50.640 look at the promise or the threat of AI and 0:00:50.720 --> 0:00:54.160 how unemployment insurance needs a huge do over if it's 0:00:54.160 --> 0:00:58.320 going to be prepared for the potential upcoming labor market disruption. 0:00:59.000 --> 0:01:02.120 But first, let's let's begin with the airline industry and 0:01:02.240 --> 0:01:06.720 consolidation deals gone unchecked for too long. Attorney General Merrick 0:01:06.760 --> 0:01:10.840 Garland himself spoke to the proposed merger between Spirit and 0:01:11.040 --> 0:01:11.639 Jet Blue. 0:01:11.959 --> 0:01:15.440 Our complaint alleges that Jet blues proposed three point eight 0:01:15.520 --> 0:01:19.640 billion dollar acquisition of Spirit violate Section seven of the 0:01:19.640 --> 0:01:23.120 Clayton Act. We allege that, if allowed to proceed, this 0:01:23.240 --> 0:01:27.039 merger will limit choices and drive up ticket prices for 0:01:27.160 --> 0:01:28.760 passengers across the country. 0:01:28.880 --> 0:01:31.480 Meanwhile, a judge has since ruled in favor of the 0:01:31.640 --> 0:01:35.440 Justice Department's efforts to unwind a deal between Jet Blue 0:01:35.440 --> 0:01:38.960 and American allowing the airlines to book each other's flights 0:01:39.000 --> 0:01:42.280 and link their reward programs, saying that it removed the 0:01:42.360 --> 0:01:45.080 incentive to be competitive and could lead to higher fares. 0:01:45.600 --> 0:01:48.720 But is this too little, too late? Brook Sutherland is 0:01:48.720 --> 0:01:52.360 a Bloomberg opinion columnist covering deals and industrial companies, and 0:01:52.440 --> 0:01:55.320 she joins us now, Brook, it is a pleasure. Thank 0:01:55.360 --> 0:01:58.200 you so much for taking the time with us today. First, 0:01:58.280 --> 0:01:59.960 let's just get down to the heat of the meat. 0:02:00.160 --> 0:02:04.960 How disciplined is airline antitrust scrutiny in the US? 0:02:05.400 --> 0:02:09.880 Well, historically not very disciplined. You know, there were a 0:02:09.960 --> 0:02:13.079 number of large murders in the industry, many of which 0:02:13.120 --> 0:02:17.280 were driven by bankruptcies. To be fair, and the thinking was, 0:02:17.360 --> 0:02:19.600 you know that by combining the airlines that you could 0:02:20.040 --> 0:02:23.040 strengthen the overall infrastructure, which was not a bad thought, 0:02:23.400 --> 0:02:26.480 but you did have a series of deals that led 0:02:26.520 --> 0:02:30.320 to a very highly consolidated industry. And the most recent 0:02:30.520 --> 0:02:33.400 large deal that happened was the combination of US Airways 0:02:33.400 --> 0:02:38.120 and the parent company of American Airlines AMR, which was bankrupt, 0:02:38.480 --> 0:02:40.840 and the Justice Department put up a bit of a 0:02:40.840 --> 0:02:43.799 fight of over that deal in twenty thirteen, but ultimately 0:02:43.840 --> 0:02:47.560 settled and allowed the transaction to proceed. Now we're seeing 0:02:47.560 --> 0:02:52.000 a very different stance, particularly from the Biden administration on 0:02:52.040 --> 0:02:56.320 antitrust overall, but particularly as it relates to airlines. And 0:02:56.400 --> 0:02:59.520 so JetBlue is really at the center of the latest push, 0:02:59.560 --> 0:03:03.119 and we'reing they had a marketing alliance with American Airlines 0:03:03.520 --> 0:03:09.280 that the Trump administration's Transportation Department actually allowed to proceed, 0:03:10.080 --> 0:03:13.240 but the Biden administration's Justice Department later came in ensued 0:03:13.240 --> 0:03:16.560 and said, actually the steal is anti competitive. A judge 0:03:16.600 --> 0:03:19.600 just ruled in the favor of the Justice Department. But 0:03:19.680 --> 0:03:22.880 Jet Blew is simultaneously also trying to buy Spirit Airlines, 0:03:22.919 --> 0:03:25.359 which the Justice Department is also taking issue with. 0:03:25.800 --> 0:03:28.360 Okay, so why now Why are they starting to pay 0:03:28.400 --> 0:03:31.200 attention now? Is it strictly who's in the White House 0:03:31.320 --> 0:03:33.880 or who has the majority on Capitol Hill? Is it 0:03:33.919 --> 0:03:36.280 all political or is there something more to it. 0:03:37.160 --> 0:03:39.080 I think that's part of it. I think it's also 0:03:39.200 --> 0:03:43.520 worth remembering the very extreme measures that the government went 0:03:43.560 --> 0:03:47.119 to to support the airline industry during the pandemic. The 0:03:47.200 --> 0:03:51.160 airlines got a lot of special dispensation that other industries 0:03:51.200 --> 0:03:54.920 that were hard hit by COVID did not get, and 0:03:55.360 --> 0:03:59.000 specifically in terms of payroll support, but also you know, 0:03:59.040 --> 0:04:01.640 there were loans made available to the airlines and also 0:04:01.720 --> 0:04:05.840 to the airspace manufacturers, although that industry didn't take the funds. 0:04:06.840 --> 0:04:09.560 And I think there's some expectation that, you know, the 0:04:09.640 --> 0:04:13.080 degree to which the tax payer propped up airline infrastructure, 0:04:13.120 --> 0:04:16.520 we would like to see a little bit better service. 0:04:16.560 --> 0:04:18.880 We would like to see this industry focus more on 0:04:19.320 --> 0:04:22.200 how it actually serves the customer. And I think that's 0:04:22.279 --> 0:04:25.839 raised some questions about airline habits that we've all long 0:04:26.080 --> 0:04:29.040 griped about but just sort of accepted as the status closed, 0:04:29.040 --> 0:04:34.039 things like families not being seated together, change fees, and 0:04:34.080 --> 0:04:35.719 you know, I think that's really focused a lot of 0:04:35.720 --> 0:04:37.920 attention on the airline industry's practices. 0:04:39.120 --> 0:04:40.880 That's what I wanted to get into when you were 0:04:40.880 --> 0:04:43.599 talking about where the focus should be. Are these the 0:04:43.720 --> 0:04:46.200 types of deals they need to be focusing on the 0:04:46.279 --> 0:04:47.840 Jet Blue and Spirit merger. 0:04:48.800 --> 0:04:51.200 I mean, it's it's difficult to sit here with the 0:04:51.240 --> 0:04:54.400 benefit of twenty twenty hindsight. But you know, the reason 0:04:54.480 --> 0:04:57.680 why that Jet Blue was pursuing this alliance with American 0:04:57.720 --> 0:05:01.679 Airlines and the takeover Spirit Airlines is that it feels 0:05:01.800 --> 0:05:05.120 like not just the airline industry, but the overall aerospace 0:05:05.160 --> 0:05:07.880 sector is so consolidated that the only way that it 0:05:07.960 --> 0:05:12.120 can really compete is by doing these transactions. And what 0:05:12.160 --> 0:05:15.680 I mean by that is that, you know, it struggles 0:05:15.720 --> 0:05:18.320 to compete with the likes of Delta and United, which 0:05:18.400 --> 0:05:19.960 you know, have a lot of airplanes, have a lot 0:05:20.040 --> 0:05:22.720 of market share, but it also can't get the plane 0:05:22.960 --> 0:05:26.039 that it wants to grow because we have very deep 0:05:26.080 --> 0:05:29.240 rooted supply chain issues in the aerospace manufacturing industry, which 0:05:29.279 --> 0:05:31.839 by the way, is also very consolidated, where we have 0:05:31.920 --> 0:05:35.960 a duopoly essentially for large aircraft, basically a duopoly for 0:05:36.000 --> 0:05:41.480 airplane engines. You know, we now have two major aircraft lessers. 0:05:41.880 --> 0:05:46.760 I think that the overall system is maybe the root 0:05:46.839 --> 0:05:49.600 of the problem, not just these specific deals, but the 0:05:49.640 --> 0:05:53.360 anti trust regulators are doing what they can to chip 0:05:53.400 --> 0:05:55.960 away what they see as an overly consolidated sector. 0:05:56.240 --> 0:05:59.240 So what will this mean then for future deals? Is 0:05:59.279 --> 0:06:02.200 this new found attention going to put a damper on those? 0:06:02.920 --> 0:06:06.240 I think, in my opinion, this Jet Blue takeover Spirit 0:06:06.360 --> 0:06:09.039 was sort of the last possible deal that could be done. 0:06:09.440 --> 0:06:12.040 And if you remember, there's actually a fight over this asset. 0:06:12.520 --> 0:06:16.279 Spirit originally had a deal with Frontier that would have 0:06:16.320 --> 0:06:18.920 combined the two ultra low cost airlines, and then Jet 0:06:18.920 --> 0:06:22.760 Blue came in and tried to buy Spirit and ultimately 0:06:22.800 --> 0:06:27.440 won the right to do so. But you know, I 0:06:27.520 --> 0:06:33.440 don't know what other major consolidation could happen antitrust being 0:06:33.520 --> 0:06:37.080 one big reason for that, and also just sheer scale 0:06:37.200 --> 0:06:40.080 of the bigger players that are involved here. And so 0:06:40.200 --> 0:06:42.400 this was really sort of the last big deal, and 0:06:42.440 --> 0:06:44.359 I think that's why you're seeing Jet Blue compete so 0:06:44.360 --> 0:06:45.200 aggressively for it. 0:06:45.440 --> 0:06:48.719 I wondered about the engine makers and the manufacturers and 0:06:48.760 --> 0:06:53.880 how this all extended beyond the airlines and to the customer. 0:06:53.960 --> 0:06:57.520 As you said, summer is here. Everybody is chomping at 0:06:57.520 --> 0:06:59.200 the bit to get out of the house and to travel. 0:06:59.279 --> 0:07:00.880 I mean, what's the like. 0:07:01.440 --> 0:07:06.640 You know, the airlines are trying really hard to invest 0:07:06.720 --> 0:07:11.160 in resilience, and they have repeatedly actually dialed back their 0:07:11.160 --> 0:07:14.000 capacity plans over the course of last year as it 0:07:14.000 --> 0:07:17.160 became clear that they were just did not have the 0:07:17.240 --> 0:07:19.400 resources that they needed to meet all this demand. But 0:07:19.440 --> 0:07:22.800 also this year they're really trying to be more disciplined, 0:07:22.840 --> 0:07:25.440 and that means offering fewer seats. Of course, the flip 0:07:25.480 --> 0:07:27.280 side of that for the consumer is that when there's 0:07:27.320 --> 0:07:29.600 fewer seats to be had, you end up paying more 0:07:29.920 --> 0:07:32.200 for the right to fly on a plane. But the 0:07:32.200 --> 0:07:34.600 airlines are doing what they can. I just think that 0:07:34.680 --> 0:07:37.760 it's a system issue as well, and we're not really 0:07:37.800 --> 0:07:40.280 seeing any kind of breakthrough in the logjam on the 0:07:40.320 --> 0:07:44.760 air States supply side. And you know, these airlines would 0:07:44.800 --> 0:07:46.800 like to get more planes, they would like to fly 0:07:46.920 --> 0:07:48.920 more and really capitalize on this demand, and you just 0:07:48.960 --> 0:07:52.080 really can't. And one interesting side effect of that has 0:07:52.120 --> 0:07:56.000 been that it's actually completely jammed up the business model 0:07:56.000 --> 0:07:58.960 of the low cost carriers. You think of that as 0:07:59.000 --> 0:08:02.720 you know, typically being a business model built on nickel 0:08:02.800 --> 0:08:06.040 and diming customers, but it's also built on growth, and 0:08:06.240 --> 0:08:08.440 the way that it works is that they outgrow the 0:08:08.760 --> 0:08:10.840 increase in their cost. Well, you can't do that if 0:08:10.840 --> 0:08:14.320 you can't get airplanes. And there's also a shortage of pilots, 0:08:14.560 --> 0:08:17.040 and you have the big airlines competing very aggressively to 0:08:17.120 --> 0:08:19.400 hire those pilots and willing to pay what they need 0:08:19.440 --> 0:08:23.080 to to attract that talent. And so, you know, I 0:08:23.520 --> 0:08:26.440 hope that it's better than last year in terms of 0:08:26.480 --> 0:08:30.200 the travel experience, but I am nervous that it won't be. 0:08:30.600 --> 0:08:32.880 I'm really curious where this may wind up, what the 0:08:33.000 --> 0:08:37.160 endgame is, because I understand that consolidation may be seen 0:08:37.280 --> 0:08:40.920 as the boogeyman at this point, even though the consolidation 0:08:41.000 --> 0:08:43.400 has been going on for so long. Just basically from 0:08:43.440 --> 0:08:45.880 what you've educated me with, it looks like it's been 0:08:45.880 --> 0:08:49.000 going on for so long that stopping one small deal 0:08:49.120 --> 0:08:52.880 here or one medium sized deal there is not really 0:08:52.920 --> 0:08:55.280 the answer what can be done at this point. 0:08:56.160 --> 0:08:57.920 I mean, I think that's sort of the issue, is 0:08:57.920 --> 0:09:00.319 that you know, you can't really go back and do 0:09:00.640 --> 0:09:03.120 all of these other deals at this point. I mean, 0:09:03.120 --> 0:09:06.600 it would be a complete mess to try to unravel 0:09:06.679 --> 0:09:09.040 the degree of consolidation that's taken place up and down 0:09:09.120 --> 0:09:12.160 this supply chain. And so I think the argument from 0:09:12.200 --> 0:09:14.040 the side of the anti trust regulators is, well, you 0:09:14.040 --> 0:09:16.760 have to start somewhere. But I think to your point, 0:09:16.840 --> 0:09:19.080 as an airline consumer, I don't know that this is 0:09:19.240 --> 0:09:22.560 necessarily going to change what you experience when you go 0:09:23.080 --> 0:09:26.680 to the airport, And you know, I think it sort 0:09:26.679 --> 0:09:30.240 of begs deeper questions of just what exactly anti trust 0:09:30.240 --> 0:09:34.000 regulators want to be. You know, I think it's very 0:09:34.000 --> 0:09:37.679 interesting that in another highly consolidated industry, the railroad industry, 0:09:37.720 --> 0:09:40.440 we had a big deal that did get approved. Now 0:09:40.440 --> 0:09:44.080 it's a separate regulator that is independent from the Justice 0:09:44.120 --> 0:09:47.600 Department and the Biden administration, but they decided that because 0:09:47.640 --> 0:09:50.640 that industry is so consolidated, the only way to allow 0:09:50.840 --> 0:09:54.360 new competition is by letting these smallest players combine. Well, 0:09:54.360 --> 0:09:57.480 that's exactly the argument that JetBlue is making here that 0:09:57.760 --> 0:09:59.560 for them to be able to really take on the 0:09:59.559 --> 0:10:02.360 big airl lines and introduce new routes offer customers better 0:10:02.400 --> 0:10:04.920 options that are pricing, they need more scale. So it's 0:10:04.960 --> 0:10:07.760 an argument that's resonating in one camp of the regulatory 0:10:07.800 --> 0:10:09.000 regime and not in another. 0:10:09.360 --> 0:10:11.840 Is there any red flag or any milestone that you 0:10:11.880 --> 0:10:14.880 are looking for in the next quarter, Perhaps that may 0:10:14.960 --> 0:10:17.720 be coming up. That's happening with the airline industry. 0:10:18.000 --> 0:10:19.480 I think we're going to be looking to see what 0:10:20.600 --> 0:10:24.400 American Airlines and Jet Blue do with this decision they're 0:10:24.480 --> 0:10:27.200 ruling by the district judge against their alliance. They do 0:10:27.320 --> 0:10:30.079 have an opportunity to appeal, and it will be interesting 0:10:30.080 --> 0:10:32.840 to see if they take that. It's worth noting that 0:10:32.880 --> 0:10:36.040 this partnership has been in existence for basically two years now, 0:10:36.080 --> 0:10:38.320 so it is not an insignificant task to try to 0:10:38.360 --> 0:10:40.800 unravel this, and they have invested a lot in setting 0:10:40.800 --> 0:10:43.240 this up. And then the next thing to watch is 0:10:43.640 --> 0:10:46.320 what happens, you know, as far as the Justice departments 0:10:46.440 --> 0:10:48.680 challenge to the Jet Blue Spirit deal. 0:10:49.440 --> 0:10:51.160 All right, Brooke, thank you so much for taking the 0:10:51.160 --> 0:10:53.400 time with us. We appreciate it. Brooks Sutherland is a 0:10:53.400 --> 0:10:58.080 Bloomberg opinion columnist covering deals and industrial companies, and coming up, 0:10:58.120 --> 0:11:01.000 we'll look at the nursing shortage the US and one 0:11:01.080 --> 0:11:05.000 idea that just might help. You're listening to Bloomberg Opinion. 0:11:13.600 --> 0:11:17.400 You're listening to the Bloomberg Opinion podcast. Catch us Saturdays 0:11:17.440 --> 0:11:20.560 at one and seven pm Eastern on Bloomberg dot Com, 0:11:20.640 --> 0:11:23.760 the iHeartRadio app, and the Bloomberg Business App, or listen 0:11:23.840 --> 0:11:26.040 on demand wherever you get your podcasts. 0:11:28.400 --> 0:11:31.400 You're listening to Bloomberg Opinion. I'm Amy Morris, and we're 0:11:31.440 --> 0:11:34.160 taking a look at two pressing issues for the United 0:11:34.160 --> 0:11:36.640 States and how they might be able to connect for 0:11:36.679 --> 0:11:40.840 the greater good. The US nursing workforce is losing good workers. 0:11:40.880 --> 0:11:44.400 One hundred thousand workers have quit or retired during the pandemic. 0:11:44.800 --> 0:11:47.800 Another eight hundred thousand have signaled an intent to leave 0:11:47.840 --> 0:11:50.600 within the next four years. But there is a pool 0:11:50.640 --> 0:11:55.120 of healthcare workers that remains untapped. Immigrants. New York Governor 0:11:55.200 --> 0:11:58.559 Kathy Hochel is calling on the federal government to expedite 0:11:58.600 --> 0:12:03.720 work visas forms awaiting asylum cases to be processed. They're 0:12:03.760 --> 0:12:05.720 eager to work, they want to work. 0:12:06.440 --> 0:12:10.040 They came here in search of work and a new future, and. 0:12:09.960 --> 0:12:13.240 They can become part of our economy and part of 0:12:13.280 --> 0:12:14.000 our communities. 0:12:14.240 --> 0:12:17.040 New York Governor Kathy Hokel. Now, let's get more details 0:12:17.080 --> 0:12:20.680 on this from Bloomberg opinion editor Rachel Rosenthal. She is 0:12:20.720 --> 0:12:24.480 also a member of the editorial board covering healthcare. Rachel, 0:12:24.559 --> 0:12:26.680 it's a pleasure. Thank you for taking the time with 0:12:26.760 --> 0:12:30.480 me today, and let's talk about those numbers. One hundred 0:12:30.520 --> 0:12:35.360 thousand leaving the profession, another eight hundred thousand talking about Yeah, 0:12:35.400 --> 0:12:39.400 I'm probably gonna leave too. Give us some perspective about 0:12:39.440 --> 0:12:42.080 what that means and what would that illustrate to you. 0:12:42.080 --> 0:12:44.680 You know, I think this has been an ongoing issue 0:12:44.720 --> 0:12:48.440 for decades. The nursing workforce has been in a shortage 0:12:48.520 --> 0:12:51.760 really since the beginning of time. You know, it's this 0:12:51.840 --> 0:12:54.080 is one of the few professions that the Labor Department 0:12:54.120 --> 0:12:56.840 has signaled that is in a perpetual shortage, and that 0:12:56.880 --> 0:12:59.920 hasn't changed. So what we're seeing right now is sort 0:12:59.920 --> 0:13:02.160 of the confluence of lots of factors. You know, we 0:13:02.240 --> 0:13:06.520 had the pandemic, and then we had several rounds of 0:13:06.920 --> 0:13:09.840 flu and RSV, and you know, while the rest of 0:13:09.880 --> 0:13:13.000 the world moved on, the healthcare workforce was left to 0:13:13.000 --> 0:13:15.640 pick up the pieces, and so they're still living in 0:13:15.679 --> 0:13:19.040 a workforce and a reality that's been hollowed out by 0:13:19.080 --> 0:13:22.160 the pandemic. So a lot of what we saw during 0:13:22.200 --> 0:13:24.840 the pandemic is a lot of older workers quit or 0:13:24.880 --> 0:13:29.400 retired early, fearful of getting sick. They have not come 0:13:29.440 --> 0:13:32.760 back yet in mass numbers, you know. And then we're 0:13:32.760 --> 0:13:36.360 also seeing on the other end, younger workers getting you know, 0:13:36.720 --> 0:13:43.080 really stressed by the new and onerous working conditions, you know, 0:13:43.720 --> 0:13:45.960 ratios of patients that they are not equipped to handle. 0:13:46.000 --> 0:13:50.960 So they're just fleeing the nursing the nursing workforce, and 0:13:51.000 --> 0:13:55.240 so what we're seeing is increased demand for services and 0:13:55.320 --> 0:13:58.360 a workforce that isn't really equipped to handle it. 0:13:58.679 --> 0:14:02.480 What is the history of immigrants within the US healthcare system? 0:14:02.600 --> 0:14:05.840 You write about this in your column on the Bloomberg terminal, 0:14:06.160 --> 0:14:08.400 and it's a connection that I had never made before. 0:14:08.679 --> 0:14:12.000 There's a long history of immigrants coming into the US, 0:14:12.120 --> 0:14:16.600 starting back actually in the early twentieth century, even before 0:14:17.320 --> 0:14:20.440 the US had a very strong relationship with the Philippines, 0:14:21.200 --> 0:14:24.320 after you know, the Spanish American War, and you know, 0:14:24.400 --> 0:14:27.880 I think there was this what ended up happening was 0:14:28.200 --> 0:14:31.720 US you know, military who was in the Philippines were 0:14:31.840 --> 0:14:34.320 they were developing these nursing schools, and so a lot 0:14:34.360 --> 0:14:38.720 of Filipino nurses would be sent to the US for training, 0:14:39.160 --> 0:14:43.480 and it sort of snowballed from there. The first nursing 0:14:43.600 --> 0:14:48.320 visa is actually in nineteen fifty two, and then it 0:14:48.360 --> 0:14:51.200 has evolved since. But what I think has happened is 0:14:51.240 --> 0:14:58.640 instead of having a specific visa for healthcare workers, there's 0:14:58.800 --> 0:15:03.520 been union objections to and various other hurdles to having 0:15:03.560 --> 0:15:07.480 it just a healthcare specific visa. So what ended up 0:15:07.480 --> 0:15:10.760 happening was healthcare workers are reliant on the overall employment 0:15:10.760 --> 0:15:14.040 based immigration category and so they're kind of, you know, 0:15:14.120 --> 0:15:17.000 in there alongside other folks who are in the backlog. 0:15:17.880 --> 0:15:21.720 And what we found is that, you know, the majority 0:15:21.800 --> 0:15:25.200 of the immigrants who end up having ability to work 0:15:25.200 --> 0:15:28.240 in the US are recipients of green cards as opposed 0:15:28.240 --> 0:15:29.200 to work visas. 0:15:29.440 --> 0:15:31.160 Yeah, I want to dig into that a little bit 0:15:31.160 --> 0:15:33.520 more because you talk about it in depth in your 0:15:33.560 --> 0:15:36.880 column how the green card system is impacting this and 0:15:36.920 --> 0:15:38.480 it's not always in a good way. 0:15:38.880 --> 0:15:41.160 Right. So there's a top of one hundred and forty 0:15:41.280 --> 0:15:44.400 thousand employment based green cards, and that has been unchanged 0:15:44.400 --> 0:15:49.760 since nineteen ninety. Obviously, the workforce has grown since then, 0:15:49.840 --> 0:15:53.360 our healthcare needs have changed since since then, so there's 0:15:53.800 --> 0:15:58.880 a reasonable argument to raise that number now, as we 0:15:58.960 --> 0:16:03.920 know immigrationses on immigration, we've gotten close several occasions in 0:16:03.960 --> 0:16:08.840 the past decades, but it's been extraordinarily difficult, and there 0:16:08.840 --> 0:16:13.880 are folks who raise legitimate concerns about how an influx 0:16:13.920 --> 0:16:18.120 of immigrants can affect wages and working conditions. But I 0:16:18.160 --> 0:16:22.920 think what's needed is a more flexible number that can 0:16:22.960 --> 0:16:24.119 reflect our demands. 0:16:24.320 --> 0:16:27.440 Part of the equation is the health of the American people. 0:16:27.680 --> 0:16:30.560 We are older, we are fatter, We are simply not 0:16:30.640 --> 0:16:33.360 as healthy as we could be or should be. We 0:16:33.440 --> 0:16:37.320 need more nurses, and that doesn't really even factor in COVID. 0:16:37.680 --> 0:16:41.200 We were just talking earlier this week about the aging population. 0:16:41.680 --> 0:16:44.200 The number of people over the age of sixty five 0:16:44.280 --> 0:16:47.760 has skyrocketed in the past ten years, and the nurses 0:16:47.960 --> 0:16:50.320 are not there for them. 0:16:50.480 --> 0:16:53.680 Yeah, I think you know it's immigration is not the 0:16:53.680 --> 0:16:56.920 only answer, you know. One of the astonishing things that 0:16:56.960 --> 0:16:59.680 I found throughout my research, and I've written on this previously, 0:17:00.200 --> 0:17:03.360 are just the fact that you have folks who want 0:17:03.400 --> 0:17:06.160 to go to nursing school and become nurses, and yet 0:17:06.240 --> 0:17:09.600 nursing schools are not equipped to handle that demand. So 0:17:09.960 --> 0:17:13.280 they don't have the faculty, they don't have the clinical 0:17:13.320 --> 0:17:18.080 training sites, and so about ninety thousand qualified applications are 0:17:18.080 --> 0:17:21.560 turned away each year. So we've got domestic problems as well. 0:17:22.160 --> 0:17:25.359 What I think where I think immigrants can fit in is, 0:17:25.400 --> 0:17:29.239 you know, if they have they're already trained, they have 0:17:29.320 --> 0:17:33.399 foreign qualifications. I'm not saying they could you know, necessarily 0:17:33.400 --> 0:17:35.840 be ready to go on day one, but theoretically, you know, 0:17:35.880 --> 0:17:40.720 if they recredential take the appropriate licensing exams, they should 0:17:40.760 --> 0:17:44.120 be qualified to work in the US. So those are 0:17:44.119 --> 0:17:47.000 folks who might be outside the US right now. There 0:17:47.000 --> 0:17:48.920 are also a lot of folks who've come to the 0:17:49.040 --> 0:17:53.680 US or already here from you know, from existing Green card, 0:17:53.720 --> 0:17:57.240 family based and are just working below their potential. Maybe 0:17:57.240 --> 0:18:00.720 they're working as an assistant or a made or even 0:18:00.800 --> 0:18:04.640 in domestic help and they were a nurse previously, and 0:18:04.800 --> 0:18:07.720 they just they are not in the workforce right now 0:18:07.760 --> 0:18:10.119 because they haven't maybe there's a language barrier, and they 0:18:10.359 --> 0:18:12.679 haven't been able to take the appropriate licensing exams. So 0:18:13.160 --> 0:18:16.760 there are there's a whole the nursing workforce. There's a 0:18:16.840 --> 0:18:19.959 really big range for you know, of skill levels that 0:18:20.000 --> 0:18:22.800 are needed. And so I think there's folks who are 0:18:22.800 --> 0:18:25.720 on the sidelines who could probably step in if they 0:18:25.720 --> 0:18:30.440 have the appropriate, expedited pathways to recredential and to get 0:18:30.480 --> 0:18:32.240 into the US workforce. 0:18:32.040 --> 0:18:34.639 Other than having to jump through hoops of fire to 0:18:34.760 --> 0:18:38.800 get into the healthcare workforce, which would apply to many 0:18:38.840 --> 0:18:41.560 people across the board. Did you find in your research 0:18:41.600 --> 0:18:45.040 that there is a resistance specifically to skilled foreign workers 0:18:45.160 --> 0:18:45.720 in the US. 0:18:46.280 --> 0:18:51.760 I think there's always a degree of anxiety about foreign workers. 0:18:51.920 --> 0:18:57.000 I think, you know, there's you know, cultural barriers, there's 0:18:57.000 --> 0:19:01.000 some degree of xenophobia in certain pockets, and there are 0:19:01.320 --> 0:19:03.600 legitimate concerns about how that effect you know, when you 0:19:03.640 --> 0:19:05.960 increase the supply of workers, what does that impact have 0:19:06.080 --> 0:19:10.600 on wages? However, I think in this case, we really 0:19:10.720 --> 0:19:14.240 need bodies in the workforce. And you know, what we 0:19:14.280 --> 0:19:19.680 saw during COVID was, you know, hospitals that were desperate 0:19:19.680 --> 0:19:22.800 for workers were turning to contract nurses who are just 0:19:23.040 --> 0:19:27.640 exorbitantly expensive, you know, and a huge proportion of hospitals 0:19:27.800 --> 0:19:30.640 costs were going to labor. They always have, but it's 0:19:30.720 --> 0:19:32.960 just skyrocket and now some hospitals could afford it, a 0:19:32.960 --> 0:19:35.760 lot of hospitals couldn't. And so what was ended up 0:19:35.760 --> 0:19:40.600 happening is you had this really vicious cycle where folks 0:19:40.600 --> 0:19:43.880 were leaving, so you know, these hospitals became more reliant 0:19:43.920 --> 0:19:46.200 on this more expensive pool of labor, and like the 0:19:46.280 --> 0:19:48.639 dynamics just got really out of wack. I think for 0:19:48.720 --> 0:19:52.120 the more stable salaried workforce, it was very destabilizing. 0:19:52.480 --> 0:19:56.920 So bottom line, immigration reform could theoretically help alleviate the 0:19:57.000 --> 0:20:01.119 nursing crisis. In addition to finding ways to streamline to 0:20:01.200 --> 0:20:04.040 allow people to get into nursing school people who do want. 0:20:03.880 --> 0:20:06.760 To contribute, there needs to be fixes on the domestic side. 0:20:06.880 --> 0:20:10.480 There need to be fixes to immigration policy. These things 0:20:10.520 --> 0:20:14.120 together can help restore a workforce that has been hollowed 0:20:14.160 --> 0:20:15.160 out by the pandemic. 0:20:15.400 --> 0:20:20.000 Bloomberg Opinion editor Rachel Rosenthal also covers healthcare and speaking 0:20:20.119 --> 0:20:23.720 of healthcare, why the UK may be a terrible place 0:20:23.760 --> 0:20:26.280 to be a doctor. We'll talk about that just ahead. 0:20:26.280 --> 0:20:30.159 But don't forget. We're also available as a podcast on Apple, Spotify, 0:20:30.480 --> 0:20:34.119 or your favorite podcast platform. This is Bloomberg Opinion. 0:20:42.040 --> 0:20:45.840 You're listening to the Bloomberg Opinion podcast. Catch us Saturdays 0:20:45.880 --> 0:20:49.000 at one and seven pm Eastern on Bloomberg dot Com. 0:20:49.080 --> 0:20:52.200 The iHeartRadio app and the Bloomberg Business app, or listen 0:20:52.280 --> 0:20:54.480 on demand wherever you get your podcasts. 0:20:56.760 --> 0:20:59.440 This is Bloomberg Opinion, I may Mee Morris. The UK 0:20:59.600 --> 0:21:03.399 is exp eperiencing a physician shortage. While the whole world 0:21:03.560 --> 0:21:06.760 is going through something of a healthcare crunch. We're all 0:21:06.880 --> 0:21:11.080 aging and there is increased demand. The UK is experiencing 0:21:11.119 --> 0:21:15.880 something even more intense. We welcome Terrees. Ralphael Therees is 0:21:15.920 --> 0:21:20.000 a columnist for Bloomberg Opinion covering healthcare and British politics, 0:21:20.040 --> 0:21:21.959 and she's going to bring us up to speed on 0:21:22.000 --> 0:21:25.320 some of these issues. Let's just start with the doctor 0:21:25.440 --> 0:21:28.640 shortage in the UK. How does that compare to things 0:21:28.680 --> 0:21:30.640 that we've seen here in the US, like the shortage 0:21:30.680 --> 0:21:34.400 of nurses or the worldwide crunch in healthcare. 0:21:35.320 --> 0:21:39.600 Yeah, so you're absolutely right to draw comparisons, because there 0:21:39.600 --> 0:21:45.119 are shortages of doctors, particularly general practitioners in most advanced 0:21:45.119 --> 0:21:47.800 countries right now, in the US, France and Germany, even 0:21:47.800 --> 0:21:52.240 the Nordic countries, and that's part of a even broader 0:21:52.280 --> 0:21:58.040 shortage in healthcare generally. The UK, as I wrote in 0:21:58.080 --> 0:22:01.480 this piece, has got all of those problems on steroids 0:22:01.520 --> 0:22:05.960 because the National Health Service is a taxpayer funded service, 0:22:06.040 --> 0:22:09.879 free at the point of delivery, so all healthcare that 0:22:10.000 --> 0:22:14.440 isn't private, which is a growing share, but let's set 0:22:14.480 --> 0:22:17.679 that aside goes through the NHS, and they're around one 0:22:17.800 --> 0:22:22.320 hundred and twenty four thousand healthcare vacancies in England. Lots 0:22:22.320 --> 0:22:26.600 and lots of nursing radiographers, but at least nine thousand 0:22:26.600 --> 0:22:30.160 of these are doctors, and that probably understates the problem. 0:22:30.240 --> 0:22:33.560 So we know that by twenty thirty and estimated one 0:22:33.600 --> 0:22:37.720 in four GP posts are are going to be vacant. 0:22:38.520 --> 0:22:40.119 And there are a number of reasons for that that 0:22:40.240 --> 0:22:44.200 you know. One of them is the doctor workforce is aging. 0:22:44.480 --> 0:22:48.080 But I think the real crisis for the NHS is 0:22:48.119 --> 0:22:51.439 not just an aging workforce. So they can't train enough doctors, 0:22:51.440 --> 0:22:54.399 they can't recruit enough doctors, and many who are in 0:22:54.520 --> 0:22:59.040