Tuesday, July 3, 2012

New England Journal of Medicine: The Health Care Jobs Fallacy

In a recent New England Journal of Medicine Article entitled The Health Care Jobs Fallacy, Drs. Baicker & Chandra question the very popular public policy assumption that growth in health care jobs is a positive economic indicator.  The article is a quick read, and begins strongly by questioning a core fallacy that more jobs means a stronger economy.  The very existence of a job does not imply that any value is actually being created, makes no comment on the efficiency of the expenditure, or if the person doing the job could be doing something more productive with his or her time.  Overall a bold move by the authors and NEJM to challenge common (and flawed) political wisdom.

However, the authors retreat from their strong opening as they maintain the position that health care is necessarily a uniform, society-wide service and must be viewed through the scope of central planning.  Talk about "losers and winners" and the boilerplate closing disclaimer paragraph (go slow, wait for evidence and expand other programs) echoes fixed-pie rhetoric that is typical of the pubic policy world.    

Working in the innovation space, I continue to lament the notion of many of my very intelligent colleagues that we can centrally design one simple health care system for all, despite the litany of failures evidencing the contrary.  It will be interesting to see how the ACA plays out, but I have little faith that any centralized attempt to "fix healthcare" will produce anything other than the complex, inhuman, politically charged system that it has already produced-- only larger, more consumptive and more toxic to innovation as it grows.  

A commendation to the authors for taking on this politically unpopular reality, and I hope that the net effect is not a subtle shift in the metrics of public policy, but a broader view of health care that puts patients (that would be all of us) and the subset of patients who act as caretakers & providers in charge of guiding the direction of this incredibly important and dynamic service. 

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