Tag Archives: health care employment

Hospitals, Social Services, and Housing: Census of Governments Employment and Payroll Data for 2017

Health care vies with elementary and secondary education as the largest destination for federal and state government spending.  In fact, when I added it up in 2006 the federal, state and local governments were already paying for 75.0% to 80.0% of third party (insurance and public program) health care expenditures nationwide, which is to say expenditures other than co-payments and services people pay for themselves in cash (such as cosmetic surgery).  Directly (Medicare, Medicaid, the VA Hospital system) or indirectly (health insurance purchased on behalf of civilian public employees and their families, the exclusion of employer funded health insurance from taxable income, other tax breaks).

Socialized Medicine? Get Real, It’s Already Here

Since then the population has aged, leading to more Medicare and Medicaid spending, Medicaid has been expanded to more working people, and Obamacare has added another form of indirect federal support for private health insurance.  For all the discussion of “socialized medicine,” here in the U.S. the government share of third party health care expenditures is probably up to 85.0% or so, and as a percent of GDP it probably exceeds the cost of the entire health care system in developed countries.

Health care and social services, however, are provided by the government primarily through payments to private sector organizations, generally non-profits in New York City and throughout the Northeast.  Therefore in this, the fifth post based on my tabulation of state and local government employment and payroll data from the 2017 Census of Governments, data on related private sector organizations from the Bureau of Labor Statistics will take center stage.   And this analysis features the most shocking trend I have found so far.

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State and Local Government Employment in 2002 and 2014: Health Care, Social Services and Housing

Health care and social assistance, along with payments to individuals, account for the largest share of government spending for the federal, state and local governments combined. They are distinguished from other government functions in two important ways. First, most of the funding comes from the federal government, even for programs that are administered by states, cities and counties. And second, most of the work is done by private, often non-profit organizations under contract or voucher systems, rather than by public employees.

This is the fifth post in a series on state and local government employment for FY 2002 to FY 2014, based on data from the Governments Division of the U.S. Census Bureau. Data on private employment in sectors substantially funded by government programs was also included in the analysis, and will be particularly important for this post. New York State in general, and New York City in particular, have had far more spending in these categories than most other places. This is explained in part by the state’s Medicaid program, the most extensive and expensive in the country, and in part by New York City’s relatively high poverty rate, although that gap is closing. And in part by New York’s virtually unique commitment to public intervention in the multifamily housing market, rather than just in subsidies for suburban expansion. The high level of spending on NYC health care, social services and housing, combined with continued high poverty and high housing costs in the city, has, over the years, raised questions about how much value has been received for the tax dollar. While employment data cannot answer those questions, it can provide some insights.

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