By MIKE MAGEE

Confrontation is good. Governor Abbott’s “We are getting out of the business of telling people what they can and cannot do” was “Neanderthal thinking” as President Biden said. Insurrectionist Richard Bennett, whose feet sat on Speaker Pelosi’s desk two month’s ago, does need to cool his jets in jail awaiting trial. And states lagging in immunizing teachers, opening schools, and accelerating their vaccine efforts need to realize that they will be held accountable by voters in the near future.

That is surface turbulence, but quietly below the surface, there are other transformational forces underway fueled by pandemic accelerants.

How long would it have taken under normal circumstances to advance equitable access to broadband and tech devices for all students in America? A decade from now, would we have advanced teacher skills in long-distance learning to the degree we are now witnessing? And how many at-home workers will be willing to return to off-site offices in the near future?

These are just a few of the questions being considering as we return to “normal” or life under the “new-normal.” And while we are all doing our best to cope with the fear and worry that comes with change, most of our collective anxiety is now focused on economic security and jobs.

This past month we added 379,000 jobs. Sounds great, that’s if you ignore the fact that there remain 9.5 million fewer jobs in our economy compared to a year ago, or that first-time jobless claims rose last week. As former Federal Reserve economist Julia Coronado reported, “We’re still in a pandemic economy.”

The Bureau of Labor Statistics in 2019 reported 3.7% growth for the coming decade. The newest update downgraded that to 1.9% if the pandemic impact is “strong”, and 2.9% if it is “moderate.”

More significant is that the pre-pandemic 2019 BLS report predicted a series of permanent changes including more remote work, higher tech service demands, further declines in travel and entertainment, and greater investment in public health and health services.

The study went to the trouble of assessing the prospects for 800 detailed ocupations over the next decade. Recently updated, the largest increases post-pandemic were in the medical, health-science and technology fields. For example, jobs for epidemiologists were projected to increase 25%.

The largest declines, as you might expect, were projected in transportation, travel and hospitality. Hidden deeper were signs of a changing world order – like the fact that if you are a computer savvy teen with only a high school education, your likely employment in the future will be in software development, not as a cashier.

In contrast to the rosy health sector jobs projections, three years ago, a deep dive into the health sector revealed huge potential for manpower shifts.

With health care now consuming close to 1 of every 5 dollars in America, the sector was a major employer. Many of those jobs delivered zero benefits when it came to patient care. In fact, there were16 health care jobs for every one physician, and 8 of those 16 were non-clinical.

A shift to a centralized health insurance system, while preserving local choice and autonomy over care delivery, carried estimated savings of up to $1 trillion off of our nearly $4 trillion annual health care expenditure. Of course that means many insurance agents, coders, billers, and data specialists would lose their jobs. What would become of them?

Likely they would follow the money. But how might that $1 trillion be best spent? The best answer was embedded in the startling fact that the U.S. is the only developed nation that spends more on health care than all other social services combined. These services – including housing, education, transportation, environmental protection, sanitation, safety and security –are all proven determinants of health.

Let’s focus on one – transportation for the elderly. 52 million people, or 16% of the American population, are over 65.  Of these, 30% have skipped their doctor appointments citing transportation problems as the cause. Missed appointments cost the health sector $200 per incident and $150 billion annually by one estimate. There are 76.4 million Baby Boomers with 10,000 crossing the age 65 threshold every day. By 2030, 21% will be over 65, and over 1/5 will be non-drivers, and 1/5 have no children to lend a hand.

In 2017, one enterprising health sector veteran saw an opportunity and seized it. Mark Switaj, a 15-year emergency medical technician created RoundTrip based in Philadelphia. Contracting with local providers and insurers, his computerized Uber like patient transportation system was able to deliver a 4% no-show rate.

How are they doing in 2021 in the middle of the pandemic? They’ve adjusted. Here’s a post from February 25, 2021: “Over the past year, as health systems have battled COVID-19 patient census surges, mobilized testing efforts, and shifted outpatient appointments, patient transportation is an essential service underpinning each of those efforts. Leading institutions like Christiana Care, Children’s Hospital of Philadelphia, and Tufts Medical Center. launched Roundtrip in the middle of the pandemic. Those organizations understood the criticality of the transportation barrier and the value their clinical teams would gain with a tool for coordinating rides for their most vulnerable patients.”

 Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“