Bryan Caplan  

Humane Canada

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How does Canada's immigration "points system" work?  While I have no plans to move to the Great White North, curiosity led me to the this online calculator.  Sadly, my Princeton Ph.D. isn't good enough for Canada.  The most revealing part of the test, though, is the health question:
Have you or any of your immediate family had any serious health problems?

Most will no doubt take it for granted that a single serious health problem disqualifies an entire family.  But to me, it's a Monty Python, "Come and see the violence inherent in the system!" moment. 

The health exclusion clearly isn't about contagion; it's about socialized medicine.  Canadians don't want to pay for foreigners' health care.  Why not admit the sick, subject to the proviso that their health care is their own problem?  Unthinkable!  By the twisted logic of the welfare state, Canadians have to pay for the health care of anyone within their borders.  Thanks to these odd qualms, foreigners endure sickness and poverty at home instead of sickness and prosperity in Canada.  And who knows, maybe a First World job would let foreigners pay for the health care they or their loved ones need, allowing them to enjoy health and prosperity without burdening Canadian taxpayers?

Canadians are hardly alone, so why single them out?  Because their blatant exclusion of sick foreigners directly contradicts their stellar international reputation for compassion and common sense.  As usual, the welfare state isn't about helping the poor and desperate.  It's about helping relatively poor and desperate members of your tribe while keeping absolutely poor and desperate human beings comfortably out of sight.  Sick.

COMMENTS (18 to date)
Sam writes:

Point taken. On the other hand, Canada brings in 250k immigrants a year, and has for over 15 years. That's 2.5x America's rate, on a per-capita basis. Of course, when other country's immigration systems aren't nearly as open as Canada's it permits some preferential selection.

Canada's immigration is therefore biased to healthy and high skill, as you note. Yet Canada also lets in a large number of refugees, which don't go through the economic immigrant system. Indeed, 1 in 10 of the world's refugees settle in Canada every year. Maybe the number could be higher, but my point is the economic immigrant and refugee systems have different priorities. And this post completely ignores the latter program.

E. Harding writes:

I agree with the general point you make here, but I don't find what Canada's doing that bad.

Eli writes:

I finished immigrating to Canada through marriage a few years ago. It took about 16 months for my stack of paperwork to get filled out, and in the meantime I couldn't work, couldn't volunteer, and couldn't leave the country. I'm not a fan.

Pajser writes:

It is only about migrating to Canada as "skilled worker", i.e people from whom Canada expect it will have more benefits than costs. Surely, it harms people who are (1) sick, and (2) who could earn enough to cure their disease in Canada - and (3) not on any other way - compared to "open border politics."

However, it doesn't follow that "absolutely poor people" are generally harmed with Canadian politics. It is possible that Canada has extensive program for helping these (through other forms of immigration or not) which is greater than it would otherwise be - because its skilled workers are healthy and therefore, benefits to "absolutely poor" are greater than harm - compared to open borders, no welfare or foreign aid politics you advocate. (Particularly because "absolutely poorest in the world" are hardly potential immigrants. Absolutely poorest cannot buy the ticket to Canada or borrow the money for it, perhaps they even do not know what is Canada.)

ThomasH writes:

The question could just be one more aspect of the general "principle," as I understand it, underlying the Canadian immigration system, maximizing the economic benefit to Canadians of the marginal immigrant. Excluding the sick (who presumable could not work as productively) is no different from excluding the uneducated and low skilled.

On the exchange with Gonzalez, I do not give much weight to the "cultural dilution" argument, but I do think that the rate of arrival of new immigrants can be too high to promote the kind of "multiculturalism" that I think you and we Liberals value.

Colombo writes:

I agree, but my personal view is that health care and social security is mostly about power and control. Life, health, survival are moot points in politics. The important thing is to oversee everything, even when it fails. Politicized doctors are not allowed to practice real medicine, as they are only government officials. Officials know all too well that they must apply the procedure, nothing more, nothing less. Anyone who opines this is good enough is a misanthrope.
In the end, the very desperate people can only hope to receive help from real human beings, not legalistic automata. Regulations obstruct the good deeds of real human beings.

Grant Gould writes:

Death is a serious health problem. Nearly everyone has a dead relative. Ergo nearly everyone is ineligible for Canada (except Canadians).

Seriously, though, how does this question not exclude an overwhelming majority of people? Is there a definition of "serious health problem" that has not touched most families? Cancer is serious, and something like 45% of people will develop it in a lifetime; the chances of a family having no history of cancer is nearly zero. There are probably other serious illnesses with comparable numbers. And that's even leaving aside mental health issues, which I assume the question is ignoring.

This seems like a question that selects people with no immediate family.

_NL writes:

Simply put, it makes no sense to condemn turning sick people away at the hospital when you are turning sick people away at the border.

Jesse C writes:

_NL - great point.

I want to see one consistent instance of socialized medicine: a state that offers free healthcare to everyone, regardless of citizenship. Ideally, subsidized travel should be included. (Like public schools that won't bus children from poorer districts - sure it's public, but only for the right subset of the public.)

Levi Russell writes:

On the broader point about who benefits from restrictions on immigration, I find that few people who are anti-immigration-restrictions have ever actually been to the southern border of the US. I'm certainly pro-immigration (though I think Bob Murphy is right that the term "open borders" is problematic) and I think our case would be strengthened if people who talk about the benefits of increased immigration actually spent some time at the border other people are concerned about.

Having lived about 2 hours from the southern border for the past 2 years, I can certainly understand why some people fear a relaxation of immigration laws. They fail to understand the link between US drug policy, crime, and immigration but Laredo, Brownsville, McAllen, and El Paso can be scary places.

Greg writes:

The site referenced ( is one of a plethora of non-government sites for immigrant applications. In Canada we have a history of dealing with shady immigration companies that purport to help immigrant applicants but only succeed in taking their money. I have no evidence either way for the legitimacy of, but I still prefer my law from a more authoritative source.

The relevant section is from the Immigration and Refugee Protection Act (IRPA) (

38. (1) A foreign national is inadmissible on health grounds if their health condition
(a) is likely to be a danger to public health;
(b) is likely to be a danger to public safety; or
(c) might reasonably be expected to cause excessive demand on health or social services.

(2) Paragraph (1)(c) does not apply in the case of a foreign national who
(a) has been determined to be a member of the family class and to be the spouse, common-law partner or child of a sponsor within the meaning of the regulations;
(b) has applied for a permanent resident visa as a Convention refugee or a person in similar circumstances;
(c) is a protected person; or
(d) is, where prescribed by the regulations, the spouse, common-law partner, child or other family member of a foreign national referred to in any of paragraphs (a) to (c).

And the definition of excessive demand from

The term "excessive demand" means

(a) a demand on health services or social services for which the anticipated costs would likely exceed average Canadian per capita health services and social services costs over a period of five consecutive years immediately following the most recent medical examination required by these regulations, unless there is evidence that significant costs are likely to be incurred beyond that period in which case the period is no more than 10 consecutive years; or

(b) a demand on health services or social services that would add to existing waiting lists and would increase the rate of mortality and morbidity in Canada as a result of the denial or delay in the provision of those services to Canadian citizens or permanent residents.

So. Excessive demand is defined as long-term above average consumption, or demand resulting in markedly poorer care for existing persons in Canada. And it doesn't apply to the applicant's immediate family (38.2(a)) or to refugees (38.2(b)). Thus, the actual rules are not as obnoxious as stated by, but perhaps not as permissive as Bryan would like.
Pajser writes:

Jesse C: "I want to see one consistent instance of socialized medicine: a state that offers free healthcare to everyone, regardless of citizenship. "

Great idea. You can extend it bit further - state that offers such healthcare to everyone, regardless of citizenship and territory. Subsidizing transport is not far from that. Many poor countries would allow to USA to make hospitals and provide medical care there. USA is wealthy enough that, if its health system is as efficient as Cuban, it can cure whole world to the Cuban level. (Country less wealthy than USA would need some utilitarian calculation - whom to help to maximize effect.)

NZ writes:

@Levi Russell:

You are to be commended for putting your money (or at least your permanent address) where your mouth is.

I moved to the SW as a very pro-immigration guy, but after about 2 years I gradually became generally anti-immigration. (My total time living there was about 3.5 years.)

You will find opponents of immigration who hold no animosity towards Latin-Americans in general--who in fact admire them as a people--and who understand the tie-in between drug policy, crime, etc. Our reasoning simply extends beyond those kind of concerns (about violence and crime, etc., though those are of course concerning).

At its most basic, it's about the degree to which we want the character of our country to be dramatically and rapidly changed by immigrants, and the degree to which certain groups and quantities of immigrants are likely to do that rather than assimilate.

Part of that equation comes from us: For example, to what extent do we unapologetically exert pressure to assimilate? Or for another example, how appealing and attainable, currently, is the middle-class family lifestyle and culture that we would likely want immigrants to assimilate to?

It sounds like you're on your way to understanding that, even if you don't end up agreeing with it, so again, kudos to you. If only the more prominent voices in the pro- side of the immigration debate were as reasonable and open-minded.

Silas Barta writes:

It's a special case of the Copenhagen interpretation of ethics: yeah, that person might be strictly better off in Canada even without free health care...

But at least when they stay out of the country, they're not our problem and we don't have to think about them! Once we interact with them, we're evil for not doing more...

Levi Russell writes:


Thanks for sharing that. I'm certainly sympathetic to the view that many other regions of the US are more dangerous than living next to the border. That said, the perception to the contrary persists. Sometimes that matters more from a rhetorical standpoint.

jdgalt writes:

It would sure incent me to get a divorce-in-name-only, go through the immigration process, then remarry.

Mike Reid writes:

I had never thought of that!

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