By Deane Waldman, M.D.
Recent labor reports suggest that health care is a thriving industry in the U.S. with a corresponding impact: better health care. Nothing could be farther from the truth.
Based on a January 2023 jobs report, the two sectors with the most growth were hospitality and health care. At the time, President Biden touted this development by calling it the “strongest job growth in history.” Yet, increasing the number of “health care” jobs not only harms Americans, it kills them. That is because much of the growth in health care jobs has nothing to do with caring for people.
The primary function of any healthcare system is medical care. Job growth that helps Americans get care would be in care providers, i.e., doctors and nurses. Some other jobs facilitate providers’ delivery of care such as technicians and pharmacists.
Non-clinical Health Care Jobs
Which jobs grew in number: care providers or middlemen, tooth or tail? In the military, “tooth” refers to those who actually fight, and “tail” refers to non-combatant roles such as logistics and intelligence. In health care, “tooth” describes direct providers of care, and “tail” is the middleman. There is one huge difference between military and healthcare tails. In the military, tail people help tooth persons achieve their objectives. In healthcare, the tail detracts from tooth function: timely medical care.
There are two categories of providers: nurses and doctors. There are thousands of health care middlemen jobs in both the business sector as well as government, federal, and state. Healthcare middlemen jobs include actuaries, administrators, agents, analysts, bureaucrats, compliance officers, consultants, lawyers, managers, regulators, rule-writer, secretaries, and a host of assistant positions.
Resources like money, time, and people used to support middlemen are taken from those who provide care. Health care spending is a zero-sum game and the resulting bureaucratic diversion has a seesaw effect: more for the tail leaves less for tooth.
A 1999 study suggested that at least 31 percent of U.S. health care spending was taken from patient care to pay middlemen. With expanded regulation of healthcare since 1999, particularly the cost of the Affordable Care Act (ACA or Obamacare) and the healthcare spending built into the Anti-Inflation Act of 2022, roughly 50 percent of our healthcare spending is being wasted on non-clinical activities.
For example, the ACA took $756 billion away from Medicare – from patient care – to pay for insurance regulations, policies, and oversight.
The U.S. spent $4.1 trillion on health care in 2021 – roughly two trillion dollars, more than the entire GDP of France, of money that produced no care. Middlemen take what they want first from the health care budget, and what remains can pay for patient care. Middlemen get the choice cuts, and patients get the leavings.
Health Care Wait Times
As the U.S. spends more money on the health care system and less on providers, wait times for care go from unconscionable to interminable resulting in death-by-queueing. That is the British term for dying while waiting in line for care. Death-by-queueing has been a long-term feature of single-payer systems and was recently highlighted in the British National Health Service where heart attack victims are dying for lack of timely care. Ironically, the British government is looking to their private sector (what little remains) to provide timely medical care because NHS can’t.
Death-by-queueing is now happening to Americans with government-provided health insurance due to bureaucratic diversion. Nick Horton reported 752 preventable deaths in Illinoisans covered by Medicaid. An internal VA analysis concluded that “47,000 veterans may have died” waiting in line for care that was technically possible but unavailable. Deamonte Driver was a 12-year old Maryland boy who couldn’t get dental care at all and eventually died from complications of a dental cavity.
As Washington expands its regulation of health care and as more people have government insurance, wait times keep going up. Before Obamacare, average maximum wait time to see a primary doctor was an already unacceptable 99 days. After ACA was implemented, wait time had increased to 122 days. That is four months to find out if belly pain is gas, ulcer, or a malignancy.
This author’s wife had to wait seven months to see her primary doctor for abdominal pain, which turned out to be inoperable pancreatic cancer. She died 22 months after diagnosis. Might things have been different if she were diagnosed seven months earlier?
The Breakdown: 25.5 Million Health Care Jobs
The recent jobs report praised by Biden does not distinguish between growth in providers – doctors and nurses – and more middlemen. To estimate, one can only depend on past data. Census data shows health care is the largest non-governmental U.S. employer at 20.5 million jobs. Add an estimated five million government, non-clinical healthcare employees, viz., Centers for Medicare and Medicaid, Health and Human Services, CDC, FDA, NIH, etc. Thus, there are at least 25.5 million healthcare jobs.
There are one million practicing U.S. physicians, although increasing numbers are retiring early. Nurses account for 5.2 million jobs (4.2 million RNs and one million LVNs). Thus, 80 percent of healthcare jobs are tail, middlemen, and non-clinicians. Taxpayers pay for these “healthcare” jobs but get no care from them.
Based on the evidence, it is likely that Biden’s touted healthcare job growth will make matters worse: even longer wait times and more Americans experience death-by-queueing. Such job growth is shameful and destructive, not something to crow about.
Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine. A version of this article appeared in Real Clear Health on February 28, 2023. Reprinted with permission.
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