The misinformation about legal immigration peddled by the Trump administration is going to get up close and personal for many of us rather quickly. Unfortunately, Trump and the anti-immigrant faction in the White House, led by Stephen Miller and the former attorney general, Jeff Sessions, has prevailed in their nativist project to grant fewer visas and approve fewer numbers of refugees. These mostly under-the-radar measures ultimately will trickle down to our health care system’s ability to provide adequate staffing and timely access to medical care.

We know that the Trump administration is, to put it mildly, fact challenged. But no matter what Trump and his merry band of alternate-reality enablers claim, objective facts about immigrants and their essential role in keeping the American health care system staffed is right before our eyes. You don’t have to go looking online, or search for the data, or Google the facts. Just take a moment to look around your local hospital, your local doctors’ offices, or your local walk-in clinics, dental offices, or urgent-care facilities. You’ll find foreign-born and educated doctors, surgeons, technicians, dentists and dental assistants, nurses, nurses’ assistants, and home health aids from across the globe who are laboring on the frontlines of delivering quality care across the country.

Facts

The numbers belie the claims that foreign-born workers, particularly in the health care industry, are taking away jobs from Americans.

• Foreign-born and foreign-educated health care professionals have actually become an essential part of America’s health care delivery system, particularly in smaller cities, rural areas, and underserved low-income communities shunned by American-educated health care workers chasing the highest wages in specialty practices in urban centers.

In a letter written to the Department of Homeland Security in 2017—during the time when the fever of executive orders banning individuals from Muslim countries was at its highest—the American Medical Association sounded the alarm about the negative impacts to America’s health care system of limiting or curtailing immigration numbers.

“To date, one our of every four physicians practicing in the United States is an international medical graduate. . . .They are more likely to practice in underserved and poor communities, and to fill training positions in primary care and other specialties that face significant workforce shortages [editor’s emphasis].”

• Internationally trained health care workers’ role in U.S. health care has steadily grown over recent decades. The foreign-born share of health care workers jumped as high as 30 percent in the 1990s, up from 5 percent in the 1960s, according to a 2014 study from Georgetown University’s Center on Education and the Workforce. Studies have found that the health care industry now has the largest percentage of foreign-born and foreign-trained workers of any industry in the country – beating out even the tech industry.
• According to the Bureau of Labor Statistics, between 2006 and 2010, the number of foreign-born health care workers increased from 1.5 million to 1.8 million. Those numbers are staggering and should be setting off alarm bells for what might happen to the health care industry and Americans’ health if the Trump/Miller immigration model prevails.
• More than one-quarter of physicians and surgeons, or 27%, were born outside the U.S. and more than one out of every five, or 22%, of individuals working in support jobs like nursing, psychiatric, home health, and janitorial services also are foreign born.

Facts are facts. Contrary to Trump and his administration’s claims that the U.S. would be better off with fewer legal immigrants, in the health care sector the reality is that Americans’ access to medical care depends on immigrants.

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Today’s battle between science and willful ignorance is not new. Scientists have always had to struggle against entrenched, non-empirical beliefs, as well as resistance to change. One battle that reason eventually won was the war on medical infections. Here’s how it unfolded:

In 1840s Vienna, a young physician named Ignac Semmelweis made a world-changing observation. Aware that childbed (“puerperal”) fever was killing as many as 25 percent of women in the days following childbirth, Semmelweis found it curious that the deaths occurred almost exclusively among women who delivered their infants in hospitals. Those who delivered at home, and those who self-delivered in alleys and streets, rarely contracted the fatal condition.

Further investigation led Semmelweiss to see a link between the standard medical-school curriculum and maternal deaths. Each day, medical students and professors discussed several cadavers, often between patient rounds. Although the concept of germs was as yet undiscovered, “Semmelweis concluded that the transmission of what he called ‘invisible cadaver particles’was the cause of childbed fever,” says Sherwin B. Nuland, MD, in Doctors, the Biography of Medicine. “The transmitting source of the ‘cadaver particles’ was to be found in the hands of the students and attending physicians.”

Fearing the terrible truth

Semmelweis then instituted the simple measure of washing hands in a chlorine solution. His hygienic practices dramatically reduced the number of deaths caused by childbed fever. But his theory met strong resistance from established physicians, who were offended by the abrasive upstart and slow to acknowledge the terrible truth that their own entrenched procedures may have caused so many deaths, writes Nuland. Semmelweis did not publish his results for another 15 years.

In the 1860s, British physician Joseph Lister broadened the battle to include post-surgical infections, which were almost universal and frequently fatal. Lister was an early adopter of Louis Pasteur’s recently postulated germ theory. Learning that a nearby city had eliminated a stench in its sewers by pouring carbolic acid down the drains, he reasoned that the chemical had killed microorganisms like those identified by Pasteur. Applying this conclusion to surgery, he then devised a wound dressing soaked in carbolic acid. Later, he added a sprayer to drench the entire surgical area in a mist of carbolic acid solution.

Soon, Lister began applying it to his hands and instruments. Lister’s first report on this treatment was published in The Lancet in 1867, the year now regarded as the birth date of antisepsis.

“Listerism” changes everything

As “Listerism” gradually gained acceptance, its principles of cleanliness caught on. The surgeon’s traditional black frock coat, elegantly tailored, stained with blood and rarely laundered, began to be covered by a rubber apron designed to protect the coat from disinfectant.

Then in the 1870s and 1880s, surgeons began to move beyond Lister’s antiseptic approach. Through new aseptic procedures, surgeons attempted to exclude infectious bacteria by boiling or heating instruments, sutures, towels and sponges. Increasingly convinced that their own clothing might be a source of infection, some surgeons began to wear loose-fitting gowns over their street clothes. Some, but not all, anesthetists, assistants and spectators also replaced their street coats with special sterilized cotton or linen coats.An elaborate ritual of hand washing became the norm, and in 1893, William Halsted became the first surgeon to wear sterile rubber gloves while performing an operation.

By 1910, surgical caps and gloves had become widely accepted. Few surgeons, however, welcomed the advent of face masks. “Early masks, which became quickly saturated with moisture from breathing and talking, irritated surgeons, especially those with beards,” writes James M. Edmunson, inSurgical Garb. “For these reasons many surgeons preferred to enforce a rule of silence during operations, rather than don a cumbersome and largely ineffective mask.”

Aseptic techniques even influenced operating room décor. By the 1920s, white gowns, starched white linens, and the sparkling white operating room symbolized the modern concept of healing.

No one, however, has yet found a way to completely eliminate hospital-based (“nosocomial”) infections. In the 1950s and 60s, a nationwide pandemic of staphylococcal infections spurred a movement toward systemic infection control in hospitals. As a result, infection control has emerged as a medical specialty, and several national organizations dedicate themselves to standard-setting education and enforcement.

Today, statistics published by the Centers for Disease Control and Prevention reveal that nosocomial infections affect about 1.7 million patients each year and contribute to 99,000 deaths.

Clearly, more than a century after the early concepts of infection control began to unfold, many challenges remain. We’re waiting for the emergence of the Semmelweises and Listers of our times. And let’s hope their new ideas are accepted.

[Adapted, updated and reprinted by permission of the American Hospital Association, who published the original article, by Gloria Shur Bilchik, in 100 Faces of Healthcare.]

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BadgerCare is Wisconsin’s healthcare plan for low-income residents—and as state healthcare programs go, it’s one of the best. Wisconsin now ranks second in the country in percentage of people with access to health care. Massachusetts, with its mandatory health insurance program, is first.

Many states have health care options for low-income families with children, as does Wisconsin. But the Wisconsin legislature saw a need for a health care plan for adults without dependent children, and created the BadgerCare Plus Core Plan.  Here are the requirements for applying. You are eligible if you:

• Are a Wisconsin resident;
• Are a U.S. citizen or legal immigrant;
• Are age 19 through 64;
• Do not have children or do not have dependent children, under age 19 living with you;
• Are not pregnant;
• Have family income at or below 200% of the federal poverty level guidelines ($1,805 for a single person and $2,428.33 for a married couple*);
• Do not have private health insurance coverage when you request Core Plan coverage or in the 12 months before that date;
• Do not currently have access to insurance from an employer;
• Cannot sign up for insurance from an employer during month of application or next three months;
• Did not have access to insurance from an employer in the 12 months before you request Core Plan coverage; and
• Are not getting BadgerCare Plus, Medicaid or Medicare.

Once an applicant is accepted to BadgerCare Plus Core Plan, the healthcare is free with the exception of $3 co-pays for doctor visits and some prescriptions, and $100 for a hospital stay. The covered benefits are remarkably comprehensive.

As of June 15, 2009, the Wisconsin Department of Health Services began accepting applications for the BadgerCare Plus Core Plan with the earliest enrollment date July 15, 2009. Unfortunately, by October 2009, the application process for the plan was suspended because the total number of applications was greater than the 60,000 slots available. A Core Plan wait list was created, and people on the wait list will be able to enroll in the Core Plan as space becomes available.

But a wait list was not good enough for Wisconsin Governor Jim Doyle. On June 1, 2010, he announced that individuals who are currently waiting for health care coverage under the BadgerCare Plus Core Plan now have the option to enroll in the BadgerCare Plus Basic plan. The Basic plan is an entirely self-funded health care plan created for more than 50,000 adults without dependent children who are on the BadgerCare Plus Core Plan waiting list. Benefits will start for some enrollees July 1, 2010. Premiums will be $130 per month.

“This will not be a Cadillac health plan,” Governor Doyle said. “In fact, it will be just what the name suggests – it will be basic.  But basic coverage can be the difference between a treatable condition and a trip to the emergency room.  And basic coverage can be the difference between having protection while you try and get your feet back on the ground and going bankrupt trying to pay for medical care.”

Members will have access to catastrophic coverage plus:

•Up to 10 physician visits each year;

•Limited hospitalization;

◦Coverage for first inpatient hospital stay and five outpatient hospital visits;

◦Subsequent stays after $7,500 deductible;

•Up to five emergency room visits each year;

•Some generic medications; and

•Badger Rx Gold discount drug membership.

The Basic plan is not designed to be a long-term health coverage plan, but is instead a temporary plan to help people take care of their health care needs while they wait for coverage on the BadgerCare Plus Core Plan. BadgerCare Plus Basic builds on Governor Doyle’s work over the last seven years to make Wisconsin a health care leader.

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