white coat notes

Health policy vs. jobs

Hospital officials frequently warn state and national lawmakers that aggressive cost controls will lead to health care job losses. But two Harvard University economists argue in a New England Journal of Medicine perspective piece published online last week that health care jobs have no place in the policy debate.

There’s a bigger employment picture to consider, Harvard School of Public Health professors Katherine Baicker and Amitabh Chandra write.

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“Salaries for health care jobs are not manufactured out of thin air — they are produced by someone paying higher taxes, a patient paying for more health care, or an employee taking home lower wages because higher health insurance premiums are deducted from his or her paycheck,” they write.

Even as job numbers in other sectors have fallen in recent years, the health care job market has continued to grow.

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“There’s no recession in health care,” Chandra said.

He and Baicker note that health care employees make up more than 10 percent of the US workforce, up from less than 4 percent in 1965. Certainly health care has improved since then. Diseases that were fatal four decades ago no longer are, and Americans live longer. But, the authors say, the cost for each year added to the average life expectancy has risen precipitously.

Such growth is unsustainable, Chandra said.

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“We can’t expect the health care industry to both deliver affordable health care and contribute to job growth,” he said. “That’s asking too much.”

The authors argue that jobs could be lost in health care, or shifted as needs change. But money saved by trimming health jobs could mean higher wages for other workers or expanded job-creation programs more likely to benefit the most vulnerable workers.

“Treating the health care system like a [wildly inefficient) jobs program conflicts directly with the goal of ensuring that all Americans have access to care at an affordable price,” they write.

The risk of health care job loss plays a more prominent role in the national debate of the Affordable Care Act, Chandra said. But Lynn Nicholas, president of the Massachusetts Hospital Association, said last month that a state House proposal to require health care to grow more slowly than the overall economy could force her members to cut hours and services.

Not taking significant steps to control health spending could mean job losses for other workers, according to a report published in April by the Blue Cross Blue Shield of Massachusetts Foundation and written by Massachusetts Institute of Technology economist Jonathan Gruber and analyst Ian Perry.

They projected that Massachusetts employers would spend $33 billion on insurance for their workers in 2019, up from $18 billion in 2010, if current trends in the growth of health costs continue. The average worker in the state would lose about $17,000 in take-home pay, including lost wages and higher premium contributions.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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