In many ways, the health-care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans - up from 1 in 12 in 2000.
As President Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health-care costs - a potentially serious job killer. It's a dilemma: One promise could run headlong into the other.
The country has grown increasingly dependent on the health sector to power the economy - and it will be a tough habit to break. Thirty-five percent of the nation's job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.
Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities, and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development - and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.
In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.
In cities such as Pittsburgh, Cleveland, and St. Louis, health care has replaced dying industries such as coal and heavy manufacturing as a primary source of new jobs. In the Philadelphia region, education and health services account for 22.5 percent of all nonfarm jobs, according to a February release from the Bureau of Labor Statistics.
"The industry accounts for a lot of good middle-class jobs and, in many communities, it's the single-largest employer," said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. "One of the hardest decisions for the new Trump administration is how far do they push on health-care costs at the expense of jobs in health care."
Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts, and medical billing coders who must decipher arcane rules to mine money from human ills.
Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.