Labor pains
Levitin, Michael
politician who could slow the skyrocketing rate of health-care costs would be popular with the electorate, which regards rising premiums and co-payments as a more serious problem than extending...
...Illegal immigration of Moroccans across the Straits of Gibraltar has been a major problem in the last decade...
...It's a prison," " a migrant told Human Rights Watch upon his release in 2001...
...That's half the money sent home by Latin Americans from across Europe, and more than double the amount per person sent home by Latin Americans living in the United States...
...So is the number from Latin America...
...This serves two purposes: it ferrets out employers who are breaking the law and, in the process, grants papers to some immigrants without work contracts...
...A larger boom began in the 1990s, when Spain's growing economy attracted immigrants from all over the world...
...Such values run contrary to Catholic teaching, which holds that death is a natural part of life...
...The number of women and youth in particular has jumped...
...Now, the feeling here is that every decision counts—from the government's reforms on education and domestic-abuse laws to debates about whether Catalan should be considered an official European language...
...Although his proposals fall short, Kerry calls for some aggressive cost-control methods...
...In August, Spain's new Socialist Party government announced that immigrants with work contracts would be offered residency papers—making them legal, or "regularized...
...You can't legally rent an apartment...
...His most recent book (with David Carroll Cochran) is Catholics, Politics, and Public Policy: Beyond Left and Right (Orbis...
...The United States has by far the most expensive medical system in the world...
...Apart from distinct regional cultures in Catalonia, Galicia, and the Basque country, Spain was more or less homogenous until the 1960s, when Muslims started arriving from Africa and the Middle East...
...Employers are required by law to offer contracts to their workers...
...Workers tend to be loyal to the people who gave them their job...
...Catholic moral theology is not opposed to the technical advances that make healing possible...
...Ill and dehydrated, the migrants are typically caged in overcrowded and unsanitary cells for up to forty days without access to a phone, lawyer, or family members...
...Some of them are deported...
...Nor will either party's proposal reach the goal of universal coverage, though Kerry's pro-gram would be a substantial down payment...
...At the same time, if hundreds of thousands of immigrants are forced to wait months or years for work or residency papers, Spain could be facing a dangerous showdown—one that pits a growing class of disenfranchised foreigners against what Merrill Lynch reports is the third-fastest growing country of "high-net-worth individuals" in the world...
...It rewards those who work within the system by obtaining work contracts, while refraining from offering residency to all illegal immigrants...
...Spain has traditionally been a country of emigrants, not immigrants...
...It's a clever idea on the surface, but seems unlikely to be very effective...
...In June, the International Organization for Migration reported that last year Latin Americans living in Spain sent more than $1 billion to their home countries...
...The former president, Jose Maria Aznar, took a hard-line stance on the immigration question, tightening laws and downsizing state immigration offices...
...Commonweal I 0 September 24, 2004...
...Those who, for various reasons, I VALERRY Commonweal 9 September 24, 2004 aren't deported are flown to mainland Spain and given expulsion orders...
...Clarke E. Cochran is professor of political science at Texas Tech University...
...There is a fear that if papers were distributed indiscriminately, even more immigrants will flood Spain's shores...
...Finally, he proposes a variety of unspecified health-promotion and disease-prevention programs...
...The first to come were students from Syria and Egypt, then later Moroccans who settled into their own communities...
...Michael Levitin LABOR PAINS Spain's migrant-worker problem is difficult being a foreigner in Spain these days...
...This puts Catholics in a tricky position...
...the problem has been lying dormant for too long...
...Spain's new racial mix was particularly noticeable last March when train bombings in Madrid killed 191 people, 47 of whom were foreigners from more than a dozen different countries...
...Bush's efforts to restrain health-care costs are more modest, relying principally on malpractice insurance reform, specifically efforts to limit punitive damages...
...Overall, progress will be possible only when voters and candidates for office form a coalition for fundamental reform that links cost and coverage...
...It's a serious Catch-22...
...politician who could slow the skyrocketing rate of health-care costs would be popular with the electorate, which regards rising premiums and co-payments as a more serious problem than extending coverage to those without insurance...
...Consider Spain's detention center in the Canary Islands, where thousands of African migrants wash up each year in small wooden boats after braving the Atlantic journey from the Western Sahara...
...Residency and work permits are nearly impossible to obtain...
...And that's if, like me, you're an American...
...The government labels you illegal three months after you arrive...
...Zapatero has also resuscitated the moribund National Employment Institute and employed 250 people to help deal with thousands of backed-up requests for papers...
...More than sixteen thousand sub-Saharan migrants have passed through the detainment camp in the last four years...
...In the coming months, the new administration will have to find a middle ground between the harsh immigration laws that have been employed thus far, and looser regulations that might attract more immigrants than Spain can handle...
...The August proposal, then, appears to be a compromise...
...Second, he would try to curb rising drug prices by negotiating lower prices with pharmaceutical companies for the government's large prescription purchases...
...Whatever road the government chooses, it will have implications for the rest of Europe: one-quarter of all immigrants to the European Union arrive via Spain...
...This is a good first step toward addressing the immigration crisis, but more reforms are needed...
...Nearly two-fifths of Spain's foreign residents come from the Latin diaspora—mostly from Ecuador and Colombia, but also from Argentina, the Dominican Republic, and Brazil...
...He has, however, refused to offer residency papers to all illegal immigrants who ask for them...
...Only a small number of immigrants hold work contracts, so the proposed reform will not help thousands of foreigners...
...Without a work permit, an employer cannot offer them a work contract...
...Finding not just immediate remedies but long-term solutions to the immigration crisis must also become a priority...
...If you're an immigrant from a poor country, life can be much grimmer...
...The chief causes are expensive medical technologies and the highly paid personnel needed to operate them...
...First, he would create a "premium rebate pool" to shift some of the expense of health-insurance premiums from employees and employers to the federal government...
...This has contributed to a growing crisis in Spain: out of the country's 2.5 million immigrants, more than 1 million are here illegally...
...They are from countries like Liberia, Ghana, and Ivory Coast...
...The new plan also offers residency papers to those who report on employers who hire workers illegally...
...And without a contract, they cannot receive residency papers...
...None of these measures is likely to have much effect on the rising bill for medical care...
...Some Spaniards have grumbled about the in-flux of immigrants, but the fact is that Spain—and Europe overall—needs them now more than ever...
...Like Kerry, Bush proposes quality-improvement initiatives...
...Spain's working-age population will start shrinking by 2010, which means that more immigrants will be needed to fill low-paying jobs...
...He also believes that wider use of health savings accounts will rein in expenditures...
...A period of economic prosperity has in some ways al-lowed Spain to overlook its immigrant crisis...
...Known as "Guantanamo 2," the former airport-cargo terminal where the migrants are processed has been condemned by Human Rights Watch and Doctors With-out Borders for its inhumane treatment of detainees...
...The most basic challenge for Catholics in health-care policy, there-fore, is to devise appropriate limits on medical care without further burdening the needy, and to discover candidates willing to support those limits...
...I didn't see the sun for three weeks...
...Spain had a babyboom (about seven hundred thousand births per year) that started in 1976, the year after Franco died, but according to a recent study by the UN, those numbers have dropped to four hundred thousand births per year...
...Although Moroccans still represent the largest immigrant group—about four hundred thousand live here legally, and at least as many are without residency papers—the number of immigrants from Pakistan, China, and Eastern Europe is rising fast...
...Fourth, he wants to reduce costly medical errors by offering incentives for improved medical technology, such as electronic monitoring of prescriptions...
...Predictably, many do not leave, but remain in Spain illegally, without residency papers or work permits, documents they need to legally apply for a job...
...Yet these very innovations fuel the expense and the hubris of the medical system, with its dream of ex-tending life indefinitely...
...The new president, Jose Luis Rodriguez Zapatero, has promised to extend health care, education, and social services for everyone, whether they're legal or not...
...Michael Levitin is a freelance journalist living in Barcelona, Spain...
...Between 1996 and 2000, the foreign population quadrupled to one million...
...But if more jobs disappear—Spain currently has the second-highest unemployment rate in Western Europe—the Spanish people may turn against those they call los sin papeles (people with-out papers...
...Third, he has proposed a variety of measures to re-duce the expense of medical malpractice insurance...
...More problematic, very few immigrants have work permits, the government-issued documents they need to apply for a job...
...Americans place great faith in medical progress, so neither political party has an incentive to take difficult steps to limit spending...
...Many have taken jobs in the booming service and tourism industries, opening Internet shops, restaurants, and other small businesses...
...Spain wasn't in the headlines much before the March 11 attacks and the Socialists' victory three days later...
...Advances in medical technology are driving rising health-care expenditure, and each new discovery fuels what is called "service intensity," the number of expensive treatments received each year by the average patient...
Vol. 131 • September 2004 • No. 16
