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Why 1.4 Million Health Jobs Have Been Lost During a Huge Health Crisis Why 1.4 Million Health Jobs Have Been Lost During a Huge Health Crisis
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For more than half a century, in good economic times and bad, health care jobs in the United States just kept increasing. Economists and health analysts thought of them as nearly recession-proof: a buffer against the business cycle.For more than half a century, in good economic times and bad, health care jobs in the United States just kept increasing. Economists and health analysts thought of them as nearly recession-proof: a buffer against the business cycle.
But like so many other patterns, the coronavirus pandemic has broken this relationship. With the virus and its fallout deterring Americans from using the health system, job losses started in March and accelerated to 1.4 million last month.But like so many other patterns, the coronavirus pandemic has broken this relationship. With the virus and its fallout deterring Americans from using the health system, job losses started in March and accelerated to 1.4 million last month.
“This is a disruption unlike any we’ve seen in decades,” said Ani Turner, the co-director of sustainable health spending strategies at the Altarum Institute, which tracks trends in health care spending and employment. Ms. Turner recently wrote an essay titled “Health Sector Won’t Be the Backstop in This Downturn.”“This is a disruption unlike any we’ve seen in decades,” said Ani Turner, the co-director of sustainable health spending strategies at the Altarum Institute, which tracks trends in health care spending and employment. Ms. Turner recently wrote an essay titled “Health Sector Won’t Be the Backstop in This Downturn.”
A sudden drop in health spending and employment amid a pandemic might seem like a paradox. But it reflects how the health industry tends to make its money: Treating patients for a deadly illness is far less profitable than offering them elective surgeries. When the federal government asked hospitals to stop such procedures to free up capacity, that changed their economics profoundly.A sudden drop in health spending and employment amid a pandemic might seem like a paradox. But it reflects how the health industry tends to make its money: Treating patients for a deadly illness is far less profitable than offering them elective surgeries. When the federal government asked hospitals to stop such procedures to free up capacity, that changed their economics profoundly.
And even if various governments across the nation hadn’t then ordered such a pause, many patients would have probably avoided doctors’ offices and hospitals anyway, to lessen the risk of contracting the coronavirus. Independent medical practices have seen huge reductions in their business, as some patients connect with doctors virtually, while many others patient visits have simply vanished.And even if various governments across the nation hadn’t then ordered such a pause, many patients would have probably avoided doctors’ offices and hospitals anyway, to lessen the risk of contracting the coronavirus. Independent medical practices have seen huge reductions in their business, as some patients connect with doctors virtually, while many others patient visits have simply vanished.
In previous recessions, the health industry has not taken such a hit. Because most Americans have health insurance, health services are more insulated from the business cycle than other kinds of spending. The biggest users of the system are older Americans. Besides being likelier to have health problems, they also tend to have comprehensive insurance coverage through Medicare and a stable source of income from Social Security. The Medicaid program, which is structured to allow people to enroll when their incomes fall, tends to offer access to health care for the poor, even if their jobs disappear.In previous recessions, the health industry has not taken such a hit. Because most Americans have health insurance, health services are more insulated from the business cycle than other kinds of spending. The biggest users of the system are older Americans. Besides being likelier to have health problems, they also tend to have comprehensive insurance coverage through Medicare and a stable source of income from Social Security. The Medicaid program, which is structured to allow people to enroll when their incomes fall, tends to offer access to health care for the poor, even if their jobs disappear.
And, of course, many of the problems that send people to the doctor — heart disease, appendicitis, cancer or the flu — do not go away during a struggling economy. As a result, the doctors and nurses and medical assistants and billing clerks who work in health care are usually protected from an economic downturn.And, of course, many of the problems that send people to the doctor — heart disease, appendicitis, cancer or the flu — do not go away during a struggling economy. As a result, the doctors and nurses and medical assistants and billing clerks who work in health care are usually protected from an economic downturn.
But lately Medicare beneficiaries, the age group at highest risk of serious disease or death from the coronavirus, have been particularly spooked from seeking medical care. And emergency rooms have reported shocking declines in visits for what doctors had always thought of as life-threatening emergencies. A recent survey of nine major U.S. hospitals showed visits for a common but serious kind of heart attack have fallen by nearly 40 percent. Those declines were seen even in places without major coronavirus outbreaks.But lately Medicare beneficiaries, the age group at highest risk of serious disease or death from the coronavirus, have been particularly spooked from seeking medical care. And emergency rooms have reported shocking declines in visits for what doctors had always thought of as life-threatening emergencies. A recent survey of nine major U.S. hospitals showed visits for a common but serious kind of heart attack have fallen by nearly 40 percent. Those declines were seen even in places without major coronavirus outbreaks.
The industry still seems somewhat protected: Health care jobs have fallen by less than jobs in the rest of the economy. But in the Great Recession, as jobs of nearly every kind plummeted, health jobs kept growing at a good clip. In the eyes of many economists, it was health care that led the economic recovery, by providing a powerful and reliable jobs engine. All those new health workers helped strengthen their local economies.The industry still seems somewhat protected: Health care jobs have fallen by less than jobs in the rest of the economy. But in the Great Recession, as jobs of nearly every kind plummeted, health jobs kept growing at a good clip. In the eyes of many economists, it was health care that led the economic recovery, by providing a powerful and reliable jobs engine. All those new health workers helped strengthen their local economies.
And in many places hit hard by the recession, the local hospital became a dominant employer, supporting entire communities. There were some small reductions in the use of health services in the following years; those led to a slowdown in what had been seen as the inexorable growth of health spending. Those changes, which earned the nickname “slowth” among health care analysts, were unusual enough to be major news. Health care still grew, however, just more slowly. About 60 percent of health care spending goes to labor, so all the growth, almost by definition, meant new jobs.And in many places hit hard by the recession, the local hospital became a dominant employer, supporting entire communities. There were some small reductions in the use of health services in the following years; those led to a slowdown in what had been seen as the inexorable growth of health spending. Those changes, which earned the nickname “slowth” among health care analysts, were unusual enough to be major news. Health care still grew, however, just more slowly. About 60 percent of health care spending goes to labor, so all the growth, almost by definition, meant new jobs.
That growth was seen as good news in the short term for the economy. But health care’s ever-growing share of the national economy has not always been seen in a positive light. The rising costs of the Medicare and Medicaid programs have meant that health care has come to represent a larger share of the federal budget, limiting capacity for other government investments. Strain under the growing costs has caused many employers to switch from older forms of insurance, which were comprehensive, to plans with high deductibles for workers, shifting the financial burden onto individuals and families, and leaving them vulnerable to big bills.That growth was seen as good news in the short term for the economy. But health care’s ever-growing share of the national economy has not always been seen in a positive light. The rising costs of the Medicare and Medicaid programs have meant that health care has come to represent a larger share of the federal budget, limiting capacity for other government investments. Strain under the growing costs has caused many employers to switch from older forms of insurance, which were comprehensive, to plans with high deductibles for workers, shifting the financial burden onto individuals and families, and leaving them vulnerable to big bills.
This downturn is clearly different, and the enormous reductions in the health work force mean the recovery may be different, too. Some of the lost jobs in health care are likely to come back later. Cancer patients who postponed chemotherapy, or people who canceled their hip replacements, will eventually want that care. But other changes may be permanent.This downturn is clearly different, and the enormous reductions in the health work force mean the recovery may be different, too. Some of the lost jobs in health care are likely to come back later. Cancer patients who postponed chemotherapy, or people who canceled their hip replacements, will eventually want that care. But other changes may be permanent.
Over just a few weeks, there has been a shift to telemedicine visits, in which patients can talk with their doctors by video, telephone or even email. Many health systems had long avoided setting up an infrastructure for them. But the new virtual visits have many advantages: Patients can avoid travel and waiting rooms; caregivers can easily participate; and several doctors can talk to the same patient at once. There are no clipboards full of personal information to fill out by hand, and no person needed to retype the answers into a computer system before such visits.Over just a few weeks, there has been a shift to telemedicine visits, in which patients can talk with their doctors by video, telephone or even email. Many health systems had long avoided setting up an infrastructure for them. But the new virtual visits have many advantages: Patients can avoid travel and waiting rooms; caregivers can easily participate; and several doctors can talk to the same patient at once. There are no clipboards full of personal information to fill out by hand, and no person needed to retype the answers into a computer system before such visits.
Updated June 12, 2020 Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Other changes are more invisible. Hospitals have been forced to find small ways to digitize processes and share records that used to involve labor and bureaucracy. Bob Kocher, a partner at the venture capital firm Venrock, has been acting as an adviser to Gov. Gavin Newsom of California through the crisis. He said he had seen hospitals adapt quickly to begin sharing their daily bed counts with one another and the state, for example, a task that used to involve hours of phone calls and faxes. Data about laboratory testing — how much is being done, how many patients have been found to have coronavirus — has been similarly digitized in real time.Other changes are more invisible. Hospitals have been forced to find small ways to digitize processes and share records that used to involve labor and bureaucracy. Bob Kocher, a partner at the venture capital firm Venrock, has been acting as an adviser to Gov. Gavin Newsom of California through the crisis. He said he had seen hospitals adapt quickly to begin sharing their daily bed counts with one another and the state, for example, a task that used to involve hours of phone calls and faxes. Data about laboratory testing — how much is being done, how many patients have been found to have coronavirus — has been similarly digitized in real time.
Are those sorts of on-the-fly tweaks enough to have an appreciable effect on long-term health care employment? Mr. Kocher thinks so, describing the recent cuts in health care administration as a “silver lining” of the crisis, while acknowledging the short-term pain of the job losses.Are those sorts of on-the-fly tweaks enough to have an appreciable effect on long-term health care employment? Mr. Kocher thinks so, describing the recent cuts in health care administration as a “silver lining” of the crisis, while acknowledging the short-term pain of the job losses.
“I will passionately say that’s a good thing, because health care costs in America are high, and most of the health care cost in America is labor,” he said.“I will passionately say that’s a good thing, because health care costs in America are high, and most of the health care cost in America is labor,” he said.
Another possibility is that the financial shock hitting smaller and less capitalized hospitals and physician practices could lead to a wave of consolidation, as bigger competitors gobble them up for a discount. Those kinds of mergers have typically led to rising health costs, since bigger systems can demand higher prices from private health insurers. That could make the legacy of this shock a more expensive health system instead of a cheaper one.Another possibility is that the financial shock hitting smaller and less capitalized hospitals and physician practices could lead to a wave of consolidation, as bigger competitors gobble them up for a discount. Those kinds of mergers have typically led to rising health costs, since bigger systems can demand higher prices from private health insurers. That could make the legacy of this shock a more expensive health system instead of a cheaper one.
“We have a great opportunity ahead of us, but I don’t see us making any progress,” said Amitabh Chandra, a health economist at Harvard, who once was a co-author of an essay describing health care as “recession-free,” and not in a good way. “I think we’ll go back to business as usual.”“We have a great opportunity ahead of us, but I don’t see us making any progress,” said Amitabh Chandra, a health economist at Harvard, who once was a co-author of an essay describing health care as “recession-free,” and not in a good way. “I think we’ll go back to business as usual.”
Either way, health care is unlikely be the economic stabilizer it has been in the past. The loss of industry jobs on top of the major losses in other sectors are likely to make the recession deeper, and the recovery slower.Either way, health care is unlikely be the economic stabilizer it has been in the past. The loss of industry jobs on top of the major losses in other sectors are likely to make the recession deeper, and the recovery slower.