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We want a cheaper, more efficient health care system. But does that mean fewer health care jobs?
At a time when many congressional conservatives are worrying about the cost of proposed health reforms, their liberal colleagues seem surprisingly unconcerned about the human cost, the inevitable loss of ten of thousands of good jobs at good wages that the nation’s older cities are increasingly dependent on.
Efforts to make American medicine more efficient threaten many of these jobs, and blacks and other minorities are likely to be the ones most affected if and when those jobs disappear.
Reformers argue that spending nearly 20 percent of the nation’s GDP on health hinders our international competitiveness—because other countries spend less on health care—and that the nation’s medical bill could be cut substantially reduced while actually improving our health if incredible amounts of waste—in the 30 percent range—could be eliminated.
Much of this waste involves doing things—ranging from prescribing drugs to doing tests to surgery—that don’t improve our health and is sometimes actually dangerous. Surgery is always risky. Scans and X-rays expose the patient to radiation that can later cause problems.
Squeezing our waste will translate into reducing employment. Reformers don’t talk about that. Their reluctance is understandable, especially in today’s economy, where the health industry is not only the nation’s largest employer, providing more than 14 million jobs, but is also one of only two areas—the other is education—now reporting steady employment growth.
In the past year, according to Bureau of Labor Statistics data, Detroit lost more than 7 percent of its jobs, but employment in health and education rose by 1 percent. Not surprisingly, these fields are already larger than manufacturing and pulling away. Nationally, general employment dipped by 3.8 percent despite job growth of 2.3 percent in these areas.
Health and education are the largest employers in Boston, Philadelphia and Pittsburgh, where they are the only sectors to add more than a thousand jobs in the years ending in March 2009. (Employment there actually increased by 5,400, consistent with a pattern that’s added more than 76,000 jobs in this category since 1990.) In New York, this category is the second largest.
So when the Wrangler plant in Texas closed a few years ago, the federal jobs program made it a priority to retrain those workers to be medical assistants.
Everyone wants a more efficient health system; it would be safer and cheaper than what we have today. Electronic medical records would eliminate duplicative tests done because prior results aren’t readily available, but would eliminate jobs filled by the technicians who are now doing these tests.
Skipping unneeded procedures would put some of those now staffing surgical suites out of work.
A better insurance reimbursement system would eliminate the mountain of paperwork that’s pushed between provider, patient and payer. It would also put the jobs of an army of paper pushers, many of whom work for hospitals that provide fringe benefits like health insurance, at risk.
Recent experience in areas ranging from telecommunications to financial services cement the link between greater efficiency and fewer employees needed to service a given number of customers. Indeed, it is very hard to imagine a more efficient American health system that doesn’t include a smaller number of jobs than the current one.
Raising this issue is not a defense of today’s clunky system that doesn’t seem to be serving anyone terribly well. It is, instead, an acknowledgement that any such change inevitably has winners and losers and that a big change like this one will have more than a few losers. How to help them make a transition to other, equally satisfying jobs is an issue that merits some thought now. As things stand, it appears that minority communities will be both the biggest winners and biggest losers if reforms are enacted. Drastically reducing the number of uninsured Americans will confer a great benefit because they are a disproportionate share of this population that is currently at risk.
But there will be a similar tilt in resulting job losses. Some doctors may see their incomes reduced a bit, but their discomfort won’t begin to match that of those who will lose jobs their families depend on.
Jim Jaffe is a former congressional staffer who worked on economic, tax and health issues.
Comments
This article is very interesting. Thank you very much for sharing .
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Are you serious? You're talking about preserving a system that kills people, that in many cases makes us sicker, leaves us with an infant mortality rate on par with third world countries, is set to gobble up 15% of GDP, and is wiping out peoples raises because to reform it would cut some JOBS?
Are you insane?
Oh no! Those people might have to find something USEFUL to do instead of being parasites of misery! Perhaps even creating more jobs in the process of developing new industries!
Heaven forbid!
Right now you can get a job at a health insurance company to deny people's claims all day long, you can get a job that requires you to cancel the coverage of people with terminal illnesses because they have high medical bills. I'd be glad to see those jobs disappear.
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Seriously, if there is a healthy business in executions, you don't try to save those jobs. Right now 40 million (probably more) people in America can't get healthcare or insurance. Right now cancer survival rates are directly correlated to income in AMERICA, no other first-world country has that problem. Don't you think that bringing all of those people in for emergency, and preventative care would create some jobs? Better jobs, you know, the ones that enable you to sleep at night?
hospital costs fairly expensive right now I think
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I, for one, am hoping that some sort of reasonable (affordable) health care plan is put into law as I am one of many paying Americans paying COBRA. When my husband was laid off, my family received the COBRA documentation from his employer and realized that we would not be able to afford the almost $900 per month payment. Because of the Obama Admin, my family can afford the COBRA payment, which is just under $300 per month.
We have a pretty good dual income, so, I don't mind paying the $300 per month COBRA for Blue Cross/Blue Shield coverage. When COBRA eligibility ends, we will check rates with the NASE or some other group membership plan, although I am hoping that by then, we have coverage soon through employment or that the Obama administration enacts plan that we can afford as we don't need free; we need fair. A plan -- goverment or competing insurance companies, that will not bail on us as we get older or give excuses for not covering any ailments which might come in the (hopefully far, far, far) future.
As the world changes, jobs will become obsolete due to technology and change in demand for certain skills. So be it -- continuing education.
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This is a very interesting thread with great commentary. Kudos.
You are right that in certain circumstances the drugs are not always better. My explanation of the system was also basic and exaggerated for better understanding. In reality the system is very complicated and far reaching in scope.
However, the process for drugs to be approved for general use is often shorter in the US compared to most other countries. 1 to 5years being the average. The FDA in the US has more money and resources which maybe the reason for the faster approval times. Industry watchdog groups have pointed out that the FDA has become no more than a servant to the drug industry though. Without proper testing new drugs can cause severe disabilities or death.
As for the Doctors being "on the take", I'm not saying that all are. Also I'm not saying they are necessarily experimenting on their patients and putting their health at risk. What I'm saying is that the pharmaceutical industry is very competitive. I wont name any names but we all know the top ones. They all compete to patent drugs and often two different companies have different drugs that do the same thing. When a hospital or doctor has a patient that needs a heart drug for instance, this is where "influence" comes into affect. The doctor doesn't have to go and search for the best one if he is already aligned with one particular company.
Someone said "well if the health system in Canada, GB, Germany, etc was so great then why are people coming to the US for care". The answer is simple. More money for r&d means better Drugs. More money into hospitals means better care. More money paid to "push" the drugs mean more good Doctors on board.
Sorry my friend, R&D doesn't make better drugs in the U.S., that's the problem. Drug patents can be and are manipulated based on what FDA members a drug company can "lobby". Even drug quality can be (and often is) bypassed via lobbying the FDA. Want an example? Crestor is one of the statin drugs said to be the panacea for cardiovascular disease, but mysteriously they stopped a 4-year trial after 2 years because the drug "showed a startling improvement in cardiovascular health". The reality was that their test patients were showing signs of liver toxicity, muscular problems and a drastically increased risk of diabetes. But amazingly, the FDA signed off on Crestor for release to the public, a $3.50 pill that 120 people would have to take every day for two years to prevent 1 heart attack/stroke among them (!) with a laundry list of side effects that negate whatever benefit the pill was supposed to have.
Worse is that the main chemical in statin drugs like Crestor is a synthetic, low dose of vitamin D, and its ability to reduce C-reactive protein isn't much better than getting 150% of the FDA recommended daily dose of vitamin E and vitamin C. Many vitamin-advocacy groups (especially vitamins C & D) have long complained that the FDA's guidelines for daily doses of vitamins are low to the point of being dangerous to people's continued health, all the while the FDA is working with the World Health Organization to find a way to remove vitamins from our store shelves (while keeping Crestor well-stocked in the pharmacy).
Whether drug company dollars provide for better hospitals is up for debate, but any doctor who violates their Hippocratic oath to peddle drugs that would potentially do more harm than good to their patients for drug company money is not a good doctor.
Welcome to the conundrum. How can a capitalist power house pursue socialist policies without sacrificing a key liberty, Free enterprise?
The Drug industry is a juggernaut, employing millions of people. I say drug because it is the drug industry that runs the medical industry. They sink billions per year into universities for research and development. From there the drugs they create goes into hospitals, prescription drugs and over the counter drugs. You might as well scratch over the counter drugs off the list because the revenue from it is a drop in the bucket compared to the others.
In hospitals and private clinics Doctors are compensated very well for "pushing" the drugs provided to them by the drug companies. For that the Insurance companies take the hit. If you are on medicare the government takes the hit. This is where government is looking to reduce costs.
So why is this a problem you might ask? Well the price for drugs are inflated a thousand percent. I prescription that costs $10 in lets say Canada costs the insurance companies and the US government $1000. Can anyone say SCAM? Allot of scam operations don't want to see this end.
Someone said "well if the health system in Canada, GB, Germany, etc was so great then why are people coming to the US for care". The answer is simple. More money for r&d means better Drugs. More money into hospitals means better care. More money paid to "push" the drugs mean more good Doctors on board. Human nature that's all. More money in the system causes a brain drain in the rest of the world. Therefore sick people with money from any country will come.
The draw back of such a system is that the poor (often Hispanic and Black) get left out. No money no care. Enterprising individuals find a use for them though. Their body parts are very valuable in the underground market. Or they are good guinea pigs.
As for changing the system. It will definately result in many lost jobs but more will open. You had a great system but too many flaws. Just like you can't force Socialism on people you can't force good will either. Everyone should be rewarded for his/her work. Just remember peoples lives should not be a commodity.
"If you want to save your job and youa lso care about really helping and healing people, then start learning about integrative and holistic medicine...."
Is this included in Obamacare? Because that's terrible if we're seriously going to pay out of the government budget for it.
"Efforts to make American medicine more efficient threaten many of these jobs, and blacks and other minorities are likely to be the ones most affected if and when those jobs disappear."
How do you come to this conclusion, when there is this:
"Blacks, Hispanics, and American Indians make up more than 25 percent of the U.S. population, but account for only 9 percent of the nation’s nurses, 6 percent of its physicians, and 5 percent of its dentists, according to a report released September 20, 2007 by the Sullivan Commission on Diversity in the Healthcare Work Force."
The only minority overrepresented in healthcare professions are Asians.
There has never been a time in history where sacrafice wasn't required in order to change a system that is broken or does not work in the favor of all people. What is a job, if that job is killing people!
WHAT WE NEED IS A REVOLUTION IN OUR HEALTH CARE SYSTEM, much less worrying about weather people will loose their jobs in a system that is helping no one. PEOPLE ARE DYING BEFORE THEIR PARENTS AND GRANDPARENTS AND THIS MUST STOP! The good, honest health care professionals who want to practice the vow of medicine "FIRST, DO NO HARM" should all be banning together and fighting for this reform too! It is YOU that knows that this system is broken and it is YOUR VOICE that will help to put this reform over! YOU WILL NOT BE OUT OF WORK! Are you kidding! With all the SICK AMERICANS IN THIS COUNTRY! Instead, you will be finding yourself doing work that is exactly the reason you entered this profession.....HEALING AND HELPING TO EDUCATE YOUR PATIENTS IN HOW TO HEAL! You may have to take the time and effort to become more educated yourself, and go back to school or take more CEU's, but isn't that what you are supposed to be doing anyway when you work in Health Care?
If you want to save your job and youa lso care about really helping and healing people, then start learning about integrative and holistic medicine....take courses in nutrition and teach people to live by the rule of Hippocrates: Let thy Food be thy Medicine! IT'S ALL ABOUT PREVENTION MEDICINE! Stop worrying and start learning....