Let’s talk about jobs

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Camille MacMillin for STAT

Adults in America exist to have jobs, or so we’re told. And there’s no industry more responsible for employing adults than health care.

“For decades, if you look at the line of health care employment, it's just trending upwards, basically uninterrupted,” said Josh Gottlieb, a professor and economist at the University of Chicago. “With the one exception of Covid, recessions and other blips in employment throughout the economy have not really shown up in health care.”

analysis

Health care giants are not universal job creators

Over the past five years, the American workforce has grown in large part due to the health care industry. But large for-profit health care companies have not been driving that job growth.

I wanted to get a sense of how job growth was changing at a more granular level. So I analyzed the number of employees listed in the annual filings of 50 of the largest publicly traded health care companies — a sample covering more than 3.3 million people. They include hospitals, pharmaceutical companies, medical device firms, health insurers, distributors, and other life sciences and equipment manufacturers.

The findings reveal a lot of variance by sector and by company, and muted total job growth. Some parts of health care — notably, health insurers — are cutting jobs, some of which has not been previously reported. For example, Elevance Health, which reported $5.7 billion of profit on $199 billion of revenue in 2025, reduced its workforce by 7,000 people in 2025, without any major divestitures. The eight largest publicly traded health insurance and services companies collectively shed 20,000 jobs last year.

Of course, caveats apply to an analysis like this (some companies don’t provide as many details, mergers and divestitures can skew things, company changes are not always reflective of broader trends, etc.). But health care is not immune to job cuts, especially when the employer has an earnings per share target to hit.

Read the story, which includes a link to the full analysis.

politics

The political importance

And yet, health care jobs are propping up the economy. America would have lost more than 200,000 jobs last year if it weren’t for the health care industry.

This power as an employer and a stable source of income for so many households across America has insulated the industry from far-reaching reforms.

“The purpose of our health care system is not to create jobs. It's to improve health,” said Neale Mahoney, a professor and economist at Stanford University. “But to understand this industry and the politics around it, you need to be aware that … in many communities, it’s the primary source of good jobs. And it is a sector where we've seen faster middle-class wage growth, more job stability, and more opportunities than many other parts of the economy.”

technology

The role of AI

The question everyone has on their mind is how artificial intelligence will reshape the health care workforce. Some are not afraid to make grand predictions based on vibes. One biotech investor, for example, recently proclaimed without evidence that most doctors will get replaced by AI.

More companies are explaining in earnings calls that AI is helping their productivity, which means fewer workers are able to do as much or more work as before. But it’s not clear to what extent AI is actually responsible for that.

“How much is AI, and how much is it firms retrenching after hiring too much coming out of the pandemic?” said Mahoney. “If you’re a CEO, it is better to tell Wall Street that you’re saving costs because of AI than [admitting] you made a mistake.”

In health care, there’s still no evidence computers can reliably replace frontline clinical workers, or that patients even want that to happen. Instead, the effect of AI will likely continue to be felt on the industry’s large administrative state that exists behind the scenes.

“I don't know how that's going to change the nature of employment, but I would be surprised if it has no effect,” Gottlieb said.

final word

A quote that stands the test of time

The demand for health care will continue to increase in the near term, as America’s population continues to gray and requires more care.

A decade ago, journalist Dan Diamond wrote a story in Politico that quoted the late health care economist Uwe Reinhardt — a quote that continues to undergird why health care remains America’s jobs program.

“Every dollar of health care spending is someone else’s health care income.”

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