Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Friday, May 28, 2010

Send flowers

The Bureau of Labor Statistics (BLS) publishes occupation pay and employment data in May of each year. The data is "as-of" May of the preceding year, since the BLS needs a year to vet data, which covers pay range and employment for 800 occupations in 400 metro areas and 291 industries. Occupations are defined by the BLS while industries are defined using the North America Industry Classification System (NAICS). This post covers changes in employment by industry from 2005 to 2009.

TheRaven has summarized occupation-by-industry data into broadly defined industry groups. Groupings attempt to vertically align industries according to basic economic themes. To be clear, the data is authoritative and covers the entire U.S. workforce, except for farming; domestic help and freelancers. Bearing in mind that industries overlap and that no grouping system is perfect, this post uses summarized BLS data to throw light on a few aspects of the US job market not found in typical reportage.  

Click any chart to see it full-size.

Reported: bankruptcies of GM and Chrysler, loss of Big-3 jobs.
Missed: the Big-3 workforce is a very small piece of total auto industry employment. Due to Big-3 outsourcing and inroads by Toyota, Honda, Subaru, Hyundai, et al, component manufacturers employ the bulk of the auto manufacturing workforce and they took the brunt of layoffs. Big-3 employees got the ink but lesser-known, lower-paid people felt the pain.

Confused by the chart? 

Left side - employment by industry, by year.
Center - color codes (chart legend)

  Important: color code sequence matches left & right, reading from top to bottom.

Right side - percentage distribution of employment, by industry, by year.

Reported: individual retailers struggled during the recession, retail layoffs, Las Vegas implosion.
Missed:
1) Florists have fared worse than the gambling industry, with a (25%) employment drop vs. (23%) in gambling.
2) "General merchandise stores" employment is up 29% over 2005, with 2009 gaining 3%.

Reported: oil prices, gas prices, "pain at the pump", "drill baby, drill", coal mine disasters, West Virginia's eternal dependence on coal, rising atmospheric carbon, climate change, oil spills.

Missed: employment in core industries of the carbon-based economy has been slowly falling, even as oil & gas exploration ramped up, and these industries account for less than 2% of the U.S. workforce.

Reported: "bailouts", tea bagger rage at the Federal government, flourishing conspiracy theories and extremist groups, "bloated Federal bureaucracy", slow dispersal of stimulus money.

Missed:
1) State & local governments employ four-times more people than the Federal government.
2) 87% of new government jobs created by the 2009 hiring surge were State & local.
3) all government jobs in 2009 accounted for only a slightly larger share of the U.S. workforce as compared to 2005.

Reported: anything branded "Apple", every Intel press release, lawsuits, video game releases, all "smart" objects, including the stupid ones.

Missed:
1) U.S. electronic manufacturing in long-term decline.
2) Digital economy jobs are up almost 10% over 2005, even after a 2% dip in 2009.
3) Systems design is flourishing.

Reported: newspaper financial trouble, Leno vs. Conan, Lost, 24.

Missed:
1) Old-media industries are in an across-the-board, long-term decline (it's not just newspapers).
2) Industry group share of U.S. workforce fell from 2.2% to 1.9%.
3) Internet-driven creative destruction is hitting in-force (aided by journalist incompetence).

Reported: organic vs. non-organic, Michael Pollan, franchise restaurant financial trouble, farming efficiencies have reduced farm employment to a tiny fraction of the U.S. workforce.

Missed:
1) Industry employment ratios from 3-4 generations ago have reversed. Where once a vast number of farmers produced food that moved through thinly-staffed distribution, a comparatively tiny farming workforce now plugs into a vast distribution network.
2) Where 3-4 generations ago very few people ate out, America now has a huge, sophisticated set of restaurant industries that have significantly displaced meals at home.
3) Almost one-in-eight U.S. workers is connected to food and this industry grouping shows a 3.8% net gain over 2005 employment, after shedding 177,980 jobs in 2009.

Reported: so-called Obama-care, so-called town-hall meetings, health-care share of GDP, hospitals feeling effects of uninsured population

Missed:
1) Hospitals & outpatient centers account for more than one-third of health care employment.
2) While hospital employment grew 7% between 2005 and 2009, ambulatory/outpatient industries grew a (combined) 18%.
3) Home care had the fastest employment growth, increasing by one-quarter between 2005 and 2009.

Reported: collapsing real estate markets, over-building, death of the suburbs, Case-Schiller, home buyer credits, foreclosures, short sales, home builder financial issues, mass layoffs.

Missed:
1) Similar to the auto industry, collapse of home building rippled through many supplier industries.
2) One-in-eight jobs related to home construction was lost with most of the decline in 2009.
3) This industry group dropped from 8.0% to 6.9% of the U.S. workforce.

Reported: "off-shoring", jobs lost to overseas competition, "no job safe".

Missed:
1) Domestic out-sourcing industries are an immense group, accounting for 1-in-9 U.S. jobs.
2) In 2009, this industry group gave up almost all the 1+ million jobs it gained over 2005-2008.
3) Employment services were crushed, losing 1 million jobs between 2007 and 2009.

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A subsequent post may look at more winners & losers among individual industries and occupations. This was the introductory, top-level view.

(All analysis by TheRaven)

Thursday, May 6, 2010

Ugly metaphor

"The Menagerie" was the only two-part episode in the original Star Trek series. Part I premiered November 17, 1966 with Part II broadcast on November 24, 1966. The Menagerie featured the wheel chair bound Captain Pike, a formerly robust man who can be restored to his former self only by the inhabitants of Talos IV, a quarantined planet. Spock risks his career getting Pike to Talos IV and in the end, after meeting a woman who shares his fate, Pike is restored to health. Talos IV becomes his prison, the price paid for absence of any other cure.


The Menagerie was first broadcast 44 years ago. Lyndon Johnson was President and the Voting rights Act was a recent event. Two generations later, The Menagerie stands as another metaphor for medical failure. While science has made great strides in combating cancer, chronic respiratory disease has yet to find a cure.


Asthma kills 7,000 people per year in the US and the related death toll is likely far greater, for example, asthma-related cardiac arrest. Emphysema, a degenerative and invariably terminal lung disease, has been re-branded as one of two diseases under the clinical and somewhat innocuous-sounding Chronic Obstructive Pulmonary Disease or COPD. The other is chronic bronchitis.


If there ever was a hard and fast line between asthma and COPD, it's gone. Science only defines a gray area in which some asthma patients develop COPD. Medications developed for COPD are prescribed to some asthma patients. At least two respiratory medications are known to cause osteoporosis.


Breast cancer has received an enormous amount of PR attention and funding. Rightly so. Breast cancer is a devastating disease. Time and money have brought breast cancer treatment to the point where early detection comes close to guaranteeing a cure. Why has respiratory disease lagged so far behind? Lung cancer is strongly associated with smoking and one could argue it acquired a "they did it to themselves" stigma. Yet 20% of lung cancer victims never used tobacco.


2010 has seen an epic level of allergy distress. Whatever your history with allergic reaction, 2010 was worse by far. There is a simple reason why pollen counts are climbing: climate change is both increasing ambient temperatures and lengthening the growing season. According to a study of pollen levels in Greece, "On average, the atmospheric pollen concentration is doubling every decade, but for some species the rate is much higher, with doubling times less than 5 years." (abstract here) Since climate change is relentless, those who suffer allergies and respiratory illness to a disabling degree will only get worse. Some are entering into a period where nature's organic response to climate change is becoming life-threatening.


COPD is diagnosed after a patient loses 30% of their lung capacity. This is akin physicians saying "..we don't know when or how asthma becomes COPD, so we'll wait until one-third of your lungs are gone before officially declaring a terminal problem.." The only practical, near-term solution for such people does not differ from the one option available to 19th century tuberculosis patients: flee to the desert.


Captain Pike found his fictional happy ending on Talos IV. Some people must make their own happy ending in places like Tucson, Albuquerque, Fort Collins or Phoenix, or suffer a miserable end where they are. Imagine a slow, painful death by suffocation, as your prescribed medications lose efficacy and your bones rot. Long before you're dead, you will be disabled, unemployed and uninsured.


There is strong historic precedent suggesting that climate change will tip the American West into an epic water crisis (for example, this book). However, large problems are viewed in a personal context. A person struggling to extract oxygen from the air might look upon a looming water crisis as a price well worth paying, if only to finally step away from medicine without health and doctors without answers.

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UPDATE 1: The New York Times is, as usual, late to the party, by this opinion piece nails a crucial issue issue in respiratory health. The underlying reason why lung cancer research is under-funded also explains why chronic respiratory disease draws disproportionately small resources, in comparison to the size of the afflicted population. Rising awareness of environmental factors that have nothing to do with elective choices, such as tobacco use, will hopefully push respiratory disease on-par with other killers, such as breast cancer.

UPDATE 2: Atul Gawande makes a young victim of lung cancer the central focus of a New Yorker essay on hospice care and the moral and economic futility of most end-of-life medical care in the United States. The piece is typical for Gawande: insightful, compassionate, self deprecating and prescriptive. There are too few informed voices to challenge our medical industrial complex. Gawande is one of the biggest and may be the most articulate.