By Derek Thompson
The Atlantic, January 9, 2018
In the last quarter, for the first time in history, health care has surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S.
In 2000, there were 7 million more workers in manufacturing than in health care. At the beginning of the Great Recession, there were 2.4 million more workers in retail than health care. In 2017, health care surpassed both.
The U.S. spends hundreds of billions of dollars each year on Medicare, Medicaid, and health-care benefits for government employees and veterans. More subtly, the U.S. subsidizes private insurance in several ways, including through a tax break for employers that sponsor health care. This public support makes health-care employment practically invincible, even during the worst downturns. Incredibly, health-care employment increased every month during the Great Recession.
Recently, the growth in health-care employment is stemming more from administrative jobs than physician jobs. The number of non-doctor workers in the health industry has exploded in the last two decades. The majority of these jobs aren’t clinical roles, like registered nurses. They are mostly administrative and management jobs, including receptionists and office clerks. It’s not always clear that these workers improve health outcomes for patients.
This isn’t the end of health care’s run. It’s just the beginning. Of the 10 jobs that the Bureau of Labor Statistics projects will see the fastest percent growth in the next decade, five are in health care and elderly assistance. The entire health-care sector is projected to account for a third of all new employment.
The work that seemed to define the 20th century in the American imagination included union jobs held by white men who made things. But manufacturing employment peaked in the late 1970s. Forty years later, the fastest-growing occupations—like personal care and home-health aides—are quite the opposite: poorly paid, lacking a strong union, often female, and disproportionately filled by immigrants (who account for one-third of the in-home health care workforce). Services are the new steel.
By Don McCanne, M.D.
So now the U.S. health care system has passed manufacturing and retail as the largest employment sector. And the majority of the newer jobs are administrative and management, according to Derek Thompson (senior editor at The Atlantic).
When we have the most expensive health care system in the world and we have so many deficiencies that result in mediocrity, is this really the best way we could be spending these additional health care dollars, especially since we already have an egregious excess of administrative services? It seems like we should be restructuring our system to make it more efficient, like maybe establishing a single payer, improved Medicare for all. Cut the waste and improve the health care product to make it work well for all of us. It will still be an important part of the job sector, but under single payer the services will provide greater health care value.
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