Free B005HFI0X2 EBOK by Michael Lind Page A

by inefficiency and rent seeking by private insurers, pharmaceutical companies, hospitals, physicians, and lawyers. But even when costs are brought into line with those of other countries, the US health-care system is likely to increase its share of the economy. One reason is the aging of the population. Another is the fact that societies, like individuals, choose to purchase more health care as they grow more affluent. Health is a good that makes possible the enjoyment of all other goods.
    Far from being a problem, then, the steady and sustainable growth of employment in the health-care sector, along with jobs providing care for the elderly and children, education, and the provision of public goods, may be the next stage in the evolution of advanced economies. As technology made possible greater production with fewer workers, first agriculture and then manufacturing shed labor to other sectors. Today, information technology, by eliminating much routine office work, is shifting labor into “proximity” services such as health care that cannot be offshored and cannot be automated. A high-tech economy leads to more “high-touch” jobs that only human beings can perform.
    Will the health aide be the typical worker of the twenty-first century, the successor to the farmer, the factory worker, and the office worker? The German poet Johann Wolfgang von Goethe would not have been surprised. In 1787, he sardonically commented: “Speaking for myself, I too believe that humanity will win in the long run; I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everybody else’s humane nurse.” 19
    The high-wage, high-consumption economy established in the United States and similar nations during the Glorious Thirty Years after World War II was easier to create than its equivalent would be today. In the mid-twentieth century, factory workers were a large enough proportion of the workforce that simply raising their wages stimulated the whole economy when they left the factory and spent money on rent, groceries, clothes, and haircuts. But gains in productivity in the highly robotic domestic manufacturing of the 2030s or 2050s may not translate into gains for the rest of society, even if the few remaining workers are very well paid. Higher pay for robot supervisors will not necessarily translate into higher incomes for home health aides.
    It is not enough to say that everyone in society benefits from the cheaper goods and services made possible by productivity. This is true, to be sure. But if an ever-greater share of the gains from national economic growth goes to a small oligarchy of capitalists and well-paid managers, then the distance between them and the rest of society will continue to increase. In the United States, the growing share of the rich of national income and wealth has already translated into much greater political dominance than existed in the days of strong unions and local political machines. If America’s rich continue to get relatively richer than the rest, they will be even more socially dominant and even more politically powerful.
    As Henry Ford recognized, workers are also consumers, who need to be paid well if they are to be able to afford the products that they make. What is required is nothing less than “service-sector Fordism”—the equivalent, in the service sector, of the Fordist system in the mid-twentieth-century industrial sector. Industrial Fordism meant that factory workers made enough money to be able to buy the products they made. Service-sector Fordism means that service-sector workers should be able to obtain the kind of services they provide. Whether from the private market or public services, health-care aides should be able to afford health care, nannies should be able to afford child care, and restaurant workers should be able to afford restaurant meals. The alternative—a return to a society in which most Americans, directly or