As the debate continues whether North Carolina should expand Medicaid, proponents claim that expansion money from the feds would create 25,000 jobs in the state – employment created by redistribution of taxpayer money. Katherine Baicker, health economist at the Harvard School of Public Health, articulately explains in the New England Journal of Medicine that an employment increase in the health care sector does not necessarily coincide with a significant improvement in patient health outcomes. It is possible that more can be done to help the most vulnerable individuals in need of medical assistance with fewer resources.

The goal of improving health and economic well-being does not go hand in hand with rising employment in health care. It is tempting to think that rising health care employment is a boon, but if the same outcomes can be achieved with lower employment and fewer resources, that leaves extra money to devote to other important public and private priorities such as education, infrastructure, food, shelter, and retirement savings. 

Salaries for health care jobs are not manufactured out of thin air — they are produced by someone paying higher taxes, a patient paying more for health care, or an employee taking home lower wages because higher health insurance premiums are deducted from his or her paycheck. Additional health care jobs leave Americans with less money to devote to groceries, college tuition, and mortgage payments, and the U.S. government with less money to perform all other governmental functions — including paying teachers, scientists, and social workers. That trade-off can be justified if it goes along with improved health outcomes, but not if those jobs do not generate benefits that exceed those of alternative uses.

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