Based on a January 2023 jobs report, President Biden touted what he called the “strongest job growth in history.” The two sectors with greatest growth were hospitality and healthcare.  Biden failed to mention though, that increasing the number of “healthcare” jobs harms, in fact kills, Americans.

The primary function of any healthcare system is medical care. Job growth that helps Americans get care would be care providers, i.e., doctors and nurses. Some other jobs facilitate providers’ delivery of care such as technicians and pharmacists. Then, there are the middlemen.

Which jobs grew in number: care providers or middlemen?

There are two categories of providers: nurses and doctors. There are thousands of healthcare 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-writers, secretaries, and a host of assistant positions.

Resources like money, time, and people used to support middlemen are taken from those who provide care.  Healthcare spending is a zero-sum game and the resulting bureaucratic diversion has a seesaw effect: more for middlemen leaves less for patients.

A 1999 study suggested that at least 31 percent of U.S. healthcare 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-in to the Anti-Inflation Act of 2022, roughly 50 percent of our healthcare spending is 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 healthcare in 2021. Roughly two trillion dollars, more than the entire GDP of France, produced no care.  Middlemen take what they want first from the healthcare budget, and what remains can pay for patient care.  Middlemen get the choice cuts, and patients get the leavings.

As the U.S. spends more money on the healthcare 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: heart attack victims are dying for lack of care-in-time.  Ironically, the British government is looking to their private sector (what little remains) to provide timely medical care because the 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 of Illinoisans covered by Medicaid.  An internal Veterans Affairs 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 healthcare and more people have government insurance, wait times keep rising.  Before Obamacare, average maximum wait time to see a primary doctor was an already unacceptable 99 days.  After ACA was implemented, wait time 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 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 healthcare 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 middlemen, 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 experiencing death-by-queueing.  Such job growth is shameful and destructive, not something about which to crow.

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.

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