America 2020: Health Care Nation

Where will the next decade's jobs grow? You'd be smart to bet on large metro areas with fewer working class folks, lots of schools, and lots of bachelor holders. As the graph above suggests, you can find a lot of these cities along the eastern seaboard, especially in the DC-Boston corridor.

That analysis comes from the Atlantic's correspondent Richard Florida, and certainly I subscribe to his belief that the future of America lives in the megatropolis rather than in the eternal exurbanization of the American family. But digging through some of his projections, I came away with another take on the American economy. We're becoming a health care nation.

You're first reaction to that statement might be: aren't we a health care nation already? We spend 16 percent of our economy of medical care. The health and education sector added more than 5.2 million jobs in the last decade, a period where the private sector grew by barely a million. The metro areas that have weathered the downturn most successfully -- under-the-radar cities like San Antonio, Albany, Harrisburg, and Poughkeepsie -- have seen resilient growth and employment numbers in part because they've leaned on health as a major pillar of their local economy.

Now look at the next ten years. The Bureau of Labor Statistics and the White House both expect health care jobs to grow nearly twice as fast as any other category. Six of the top eight jobs with the fastest projected growth are in the health care or medical science industries. Three of the top five jobs with the largest projected growth are in health care.

A richer nation has every right to spend more money on staying alive, right? Right. But the medicalization of the country has repercussions. On the one hand, we project that a quarter of all new jobs created in the U.S. economy will be in the health care and social assistance industry. On the other hand, there are representatives and thought leaders on Capitol Hill drawing up plans to dramatically shrink the nation's dependence on health spending through rationing. Moderate rationing might be a prudent way to control costs. But one man's cost is another man's meal ticket. When we talk about slaying the medical inflation beast, we're also talking about slowing a key motor of our job economy.

Health costs are accelerating, but higher education costs are growing just as wildly. The total debt on student loans just hit $830 billion, more than the country's credit card debt. The recession has made clear that bachelors degrees work like a flotation device in the deluge (see graph to the right). But here's an inconvenient fact: the seven fastest growing jobs in health services don't require a bachelors degree, at all. Five require short-term job training, such as home health aides (#2) and serving food (#4). Americans should want a smart and capable workforce. But, we should ask, at what cost?

None of this is to detract from Florida's thesis that education-fueled creativity and human capital produce successful cities. But it does suggest that we're moving not only toward a white-collar economy, but toward a white-coat economy, and that such a revolution might challenge our political will to curb medical costs and our social goal for universal higher education.