"All the hospitals, each of the individual doctors, are individual entrepreneurs and they are all trying to maximize profits. And you have a third-party payer, which in many cases is the government, if I want something and somebody else pays for it, I tend to consume more of it," he says. "It is not a market. It needs to be rationalized to the extent that there is some relationship between consumption and cost; that there are prices attached to things and people make choices; where there is some discipline in the system that discourages waste."
"In most rational systems that means somebody has to be in control. The politics of healthcare are such that it is very difficult to arrive at that," he says. "To the extent that each of us wants to be an independent consumer and every provider wants to be an independent entrepreneur, you have a recipe for a runaway train in economic terms and that is what we have."
The study also found that:
- 82% of those new healthcare jobs—4.6 million—will require postsecondary education. As a result, Carnevale says, the demand for postsecondary education in healthcare will grow faster than in any other field except STEM (Science, Technology, Engineering, and Mathematics) and Education occupations.
- Healthcare successfully competes for science and engineering talent. Healthcare, science, and technology fields require similar skills and healthcare programs at the associate and bachelor's level provide appealing alternatives for science and engineering students.
- Healthcare reflects distinctly different work interests and values. People in healthcare jobs tend to value forming social bonds. People who gravitate to STEM occupations place a greater emphasis on achievement and independence.
- Upskilling in nursing is growing especially fast. In 1980, 37% of entry-level registered nurses had at least an associate's degree; by 2008, that figure had increased to 80%.
- Bachelor degree requirements in nursing is crowding out disadvantaged minorities. A total of 51% of white nurses 40 years old or younger have bachelor's degrees, compared to only 46% of Hispanics and 44% of African American nurses.
- Healthcare has the largest number and proportion of foreign-born and foreign-trained workers in the U.S. Among healthcare workers 22% are foreign born, compared to 13% of all workers nationally. Most foreign-born nurses come from the Philippines, India and China.
- Physicians are the highest income earners in the country and tend to come from mostly affluent backgrounds.