Blog postings by CEPR staff and updates on the latest briefings and activities at the Center for Economic and Policy Research.

Healthcare, which accounts for 12.8 percent of private sector employment is one of the most important sources of jobs in the economy. In our report, Organizational Restructuring in U.S. Healthcare Systems: Implications for Jobs, Wages, and Inequality, we examine in great detail what has happened to workers over the decade from 2005 to 2015 as the consolidation of hospitals and the decentralization of health services and jobs accelerated.

In this blog post, we examine broad trends in employment and wages. Overall in health care, private sector employment grew by 20 percent from 2005 to 2015. Hospitals continue to provide the lion’s share of Jobs, but employment grew by just under 10 percent in this decade, more slowly than in healthcare overall. By contrast, employment in the much smaller outpatient care sector increased by almost 60 percent – six times faster than in hospitals.

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The drop in employment rates among workers — and especially men — without college degrees has been widely noted. The employment rate for men over the age of 25, with just a high school diploma is down by more than 5.0 percentage points compared with its pre-recession level in 2007. It is down by more than 7.0 percentage points when compared to its 2000 level.

While this drop in employment rates is not in dispute, the explanation is. The predominant view in the economics profession is that the drop is explained mostly by changes in the labor market and changes in the motivations of this group of men.

The labor market explanation hinges on the idea that the spread of technology has reduced the need for workers without more education. We need fewer people now to dig ditches or to turn screws on assembly lines. This argument holds that the declining employment rate among men is part of a long-term trend, so we shouldn’t find the drop in recent years surprising.

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Two years ago, in August of 2015, the national unemployment rate stood at 5.1 percent. This was at or below widely accepted estimates of the non-accelerating inflation rate of unemployment or NAIRU. This meant that if these estimates were right, the inflation rate would start to increase if the unemployment rate fell further or possibly even if it stayed at its 5.1 percent level.

As it turns out, the unemployment rate has continued to fall and stood at 4.3 percent in August of 2017. Inflation has remained steady or even fallen slightly. By all measures, it is below the 2.0 percent rate targeted by the Federal Reserve Board.

Many economists, including some at the Fed, wanted to raise interest rates enough to prevent any further decline in unemployment out of concerns over inflation. Fortunately, the Fed did not go along with this position.

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The Bureau of Labor Statistics reported that the economy added 156,000 jobs in August, somewhat less than most economists had expected. This figure, combined with downward revisions of 41,000 to the prior two months data, brought the average over the last three months to 185,000. The household survey also showed some evidence of weakness with the unemployment rate edging up to 4.4 percent and the employment-to-population ratio falling back 0.1 percentage point to 60.1 percent. Perhaps more noteworthy was a drop of 0.3 percentage points in the employment rate of prime-age (ages 25 to 54) workers to 78.4 percent.

Other data in the household survey were mostly positive. The number of people involuntarily working part-time fell by 27,000; it is now only slightly larger as a share of the workforce than before the recession. The number of people choosing to work part-time went up by 187,000, reaching a new high. This number has increased by more than 2.6 million since the end of 2013 when the Affordable Care Act took effect. It indicates that many people are taking advantage of the opportunity to get insurance outside of employment and therefore opting to work part-time.

Wage growth continues to be moderate, with the average hourly wage up 2.5 percent over the last year. The annual rate of increase in the average hourly wage, comparing the last three months with the prior three months, is also 2.5 percent. As a result of the weak growth in the hourly wage and a modest decline in the length of the average workweek, average weekly earnings actually fell slightly in the month.

The job growth in the establishment survey was unusually concentrated in the good producing sector, which accounted for 70,000 new jobs. Manufacturing led the way with a gain of 36,000, of which 13,700 were in autos. Construction added 28,000 jobs, an unusually large gain. Mining added 6,500 jobs as a result of a gain of 6,800 jobs in support activities for mining. Coal mining jobs were unchanged and now stand 2,100 above their year-ago level. Job growth in health care was just 20,200, down from an average of about 27,000 over the last year. Job growth in restaurants was also weak at 9,200.

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Trump’s Medicare trustees recently released their report on the health of Social Security and Medicare. Trump’s trustees reported that there was a sharp improvement in the projections of Medicare’s finances during the Obama administration – this is notable because it signals bipartisan agreement that the projected shortfall is markedly smaller than what policymakers were looking at a decade ago.

Some critics of the Obama administration questioned the validity of this projection and accused the Trustees, four out of six of whom are political appointees of the president, of manipulating the numbers for political purposes. These critics claimed that Obama’s trustees were deliberately understating the financial problems facing Medicare over its planning horizon.

For this reason, the fact that the 2017 Trustees report largely confirms the drop in the shortfall projected by the Obama trustees is very important. In fact, the 2017 report shows an even better picture for Medicare, with a projected shortfall of just 0.64 percent of payroll over the 75-year planning period.

This new projection implies that almost 82 percent of the projected shortfall was eliminated by economic and policy changes during the Obama years. In fact, this figure understates the true improvement since the 75-year horizon starting in 2017 includes years that are considerably worse for the program demographically than 75-year horizon that began in 2007.

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Since 2014, 14 million workers have gained access to paid sick days. Breakdowns of this finding, part of the latest National Compensation Survey conducted by the Bureau of Labor Statistics (BLS), show across-the-board increases in workers' ability to take time off when they are ill without facing financial burden. State and local laws, now totaling 40 (seven states, two counties, and 31 cities), have been instrumental in extending paid sick leave benefits to more workers.

More workers now have access to paid sick days

According to the BLS report, 72 percent of civilian workers, or 97.3 million people, have access to paid sick days as of March 2017, compared with 83.3 million people (65 percent) in March 2014. Over just three years, access expanded by seven percentage points, with 14 million additional workers covered. As shown below, the increase in access since 2014 covers all groups but is particularly strong for part-time workers and those earning lower wages.

PSD
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The Bureau of Labor Statistics reported the economy added 209,000 jobs in July, somewhat more than what the consensus estimated. The revisions to the prior two months data were largely offsetting, so bringing the three month average to 195,000. The strong job growth brought the unemployment rate back down to the 4.3 percent rate reached in May, the low for the recovery. There was also a slight uptick in the employment-to-population ratio to 60.2 percent, a new high for the recovery.

Some of the other data in the report were more mixed. While the single month wage growth was strong at 9 cents per hour, this is a very erratic figure. The rate over the last twelve months was 2.5 percent.

Furthermore, the average wage for the last three months compared with the prior three months grew at just a 2.3 percent annual rate. While this is a very modest deceleration, clearly it is not possible to make the case that wage growth is accelerating in spite of the relatively low unemployment rate.

The percentage of unemployment due to voluntary quits fell back to 10.9 percent. By comparison, this figure was over 12.0 percent in 2006 and 2007 and peaked at more than 15.0 percent in 2000. The low share of quits suggests that workers are not confident in their labor market prospects.

It is also worth noting that the data continue to refuse to comply with the skills shortage story. The employment rate for college grads actually fell 0.2 percentage points in July and is unchanged over the last year. By contrast, the employment rate for those with just a high school degree is up by 0.8 percentage points over the last year.

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The healthcare sector is one of the most important sources of jobs in the economy. It accounts for nearly 18 percent of GDP and almost 14 percent of private sector jobs. It is the only sector that consistently added jobs during the Great Recession.

Overall industry employment grew by 20 percent between 2005 and 2015 and in 2016 it added 381,000 jobs, more than any other industry. Despite strong employment growth, however, median real wages of full-time, full-year healthcare workers declined 2.4 percent between 2005 and 2015 – falling 49 cents an hour from $20.22 to $19.73. This decline in real wages was led by the decline in pay for black women.

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Last week four prominent Republican economists, John Cogan, Glenn Hubbard, John Taylor, and Kevin Warsh released a short paper arguing that it would be possible to have substantially more rapid growth if we cut taxes and reduced regulation. A big part of their story was that we would see substantially more labor force participation if workers faced lower tax rates, and therefore got to keep a larger share of their pay.

While there are many factors that affect people’s decision to work other than tax rates, such as before tax pay and access to child care, it is worth looking at what happened to employment in the years following the tax cuts put in place by President George W. Bush in 2001. This is an interesting question because President Clinton raised taxes in 1993, although the tax increase almost exclusively affected upper income people. Nonetheless we can compare a higher tax period, 1993-2001, with a lower tax period, 2001-2012. Taxes for high-end earners rose in 2012.

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With the release of the annual Social Security and Medicare trustees’ report, President Trump’s appointees endorsed sharp improvements in Medicare’s financing that occurred under former President Obama. Medicare had a projected shortfall of 3.54 percent of covered payroll (over a 75-year planning period) during the last year of the Bush administration, now it is down to just 0.64 percent.

This development should give pause to those who wish to fundamentally restructure Social Security and Medicare based on these projections. A lot changed over the eight years of the Obama administration and even more can change over 75 years. This is worth taking into account when looking at Social Security’s 75-year shortfall, which is at 2.83 percent of payroll under the intermediate scenario.

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Back in the 1990s stock bubble it was common for analysts to say things like price-to-earnings ratios (PE) no longer mattered. They were right, at least for a while, as the stock valuations of companies like AOL and Priceline soared way beyond anything that could conceivably be justified by current or future earnings.

Of course after a while, price-to-earnings did come to matter, as the stock market lost half its value from its peak in March of 2000 to its trough in the summer of 2002. The tech heavy Nasdaq lost close to 80 percent of its value. Many of the big tech enthusiasts were wiped out in this crash. While it might seem old-fashioned, people presumably value stock based on how much earnings a share commands, not the beauty of the stock certificate or how cool the company is.

With this in mind, it is interesting to think about what the Amazon future might look like given that it now has a market capitalization of roughly $480 billion with current profits of roughly $2.6 billion. This gives it a price-to-earnings ratio of 184 to 1.

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While business cycles vary in their length and growth rates, there are some consistent patterns. Most obviously, the labor market tightens as the business cycle advances with unemployment falling and the percentage employed rising. This tightening of the labor market increases the bargaining power of workers since they are more likely to have a choice of jobs than they did during the downturn or during the early phase of the recovery. As a result, workers are likely to move to more desirable and better-paying jobs. Better paying jobs are also likely to be more productive jobs, which mean that the shift in employment patterns as a result of a tightening labor market could provide some boost to productivity growth. (This is offset in part by the fact that large numbers of people shifting jobs will reduce productivity.)

This pattern is likely to be especially strong among less-educated workers since they are the ones most likely to lose their jobs in the downturn. An employer is far more likely to lay off a retail clerk or assembly line worker than a store manager or a shift supervisor. This means that the improved labor market situation during the upturn is likely to disproportionately benefit workers at the bottom end of the wage distribution.

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As discussed in a recent Federal Reserve staff working paper, “recessions may impact different groups at different phases of the aggregate business cycle”. The paper finds that in an economic downturn jobs losses disproportionately hit black and Hispanic workers relative to white workers, while periods of unemployment likewise last longer for black and Hispanic Americans. As a result, in the later stages of an economic recovery new jobs are added at a more rapid rate for black and Hispanic workers.

An important monetary policy implication of this finding is that the gap in labor market outcomes for different groups is affected by how quickly the Fed raises interest rates in an economic recovery. Put another way, if the Fed moves too quickly to raise interest rates, it will disproportionately leave black and Hispanic Americans out of the labor market, and particularly black and Hispanic women and youth.

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The unemployment rate rose very slightly to 4.4 percent in June, as the estimated size of the labor force expanded at its fastest rate (361,000) since last July (406,000). This is the third consecutive June in which the labor force estimate reversed a big change in May. Thus, despite the rise in the unemployment rate, the 245,000 net new jobs in June raised the overall employment-to-population ratio from 60.0 percent in May to 60.1 percent in June.

The establishment survey showed further evidence that last month’s seeming weakness was a little misleading. Job growth rose to 222,000 in June, and these nonfarm payroll jobs for April and May were revised up by 47,000.

Finally, average hourly wages ticked up by 4 cents in June, and 2.5 percent over the last twelve months.

Thus, people continue to return to the labor force as jobs continue to be made available. This suggests that despite low unemployment there is room for growth.

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President Trump and Republicans in Congress have repeatedly charged that the Affordable Care Act (ACA) is collapsing. They point to insurers dropping out of the exchanges and endlessly cite the fact that more than 1300 counties across the United States only have one insurer operating in the exchanges and that some will not have any in 2018.

The lack of competition in the exchanges is a serious problem. While people can still buy insurance in the individual market off of the exchange, and still benefit from the ACA prohibition against discrimination based on pre-existing conditions, they are not eligible for ACA subsidies unless they buy insurance through the exchanges. These subsidies are necessary to make insurance affordable for millions of people.

So, the lack of a vibrant market in many counties is a serious issue for the ACA. However, there is an important part of the story that Trump and other Republicans forget to mention. The lack of competition in the exchanges is overwhelmingly a problem for people living in states controlled by Republican governors.

The graph below shows the number of people living in counties that only have one insurer in their exchange by the party of the state’s governor.

health_insurance_by_governor_chart1

As can be seen over 40 million of the people in counties with only one insurer in the exchanges live in states with Republican governors. By comparison, just 10.7 million people who only have one insurer in the exchanges live in states with Democratic governors.

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Prescription drugs are a large and growing share of national income. While it is generally recognized that drugs are expensive, many people are unaware of how large a share of their income goes to paying for drugs because much of it goes through third party payers, specifically insurance companies and the government.

The Centers for Medicare & Medicaid Services (CMS) produce projections of national expenditures on prescription drugs through 2025, along with historical estimates dating back to 1960. As shown below, prescription drug spending from 1960 to 1980 was equivalent to about one percent of total wage and salary income. In the years leading up to the passage of the Bayh-Dole act in 1980, wage income was rising faster than spending on prescription drugs. As a result, the share of wages spent on prescription drugs was actually falling, reaching a low in 1979 of 0.86%.

Prescription Drug Spending Relative to Wages
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Which industry you work in has a large effect on the extent of living standard improvement you've seen during the 21st century, according to data on the earnings of production and non-supervisory employees. Since 2000, the growth in workers' purchasing power (their ability to use earnings to buy goods and services) has varied strongly by industry sector. Per hour worked, financial sector employees are able to purchase 24.6% more goods and services than they could in 2000, while manufacturing employees have attained only 2.5% percent total growth in purchasing power over the 17-year period. Workers in the retail trade (-0.3%) and transportation and warehousing (-0.6%) sectors have seen their purchasing power deteriorate.

Worker Purchasing Power Growth by Industry

Much of the difference depends on the overall health of the economy as workers in some industries are more vulnerable to swings in the economy. During an economic downturn or periods of low economic growth, manufacturing workers are more likely to be laid off than doctors. This tendency has direct consequences for the manufacturing workers who are not laid off, as the availability of unemployed workers makes it possible for employers to offer fewer or smaller wage increases without their employees quitting. In cases where workers can easily move across industries, job loss in one industry will lead to lower wages in related industries.

So how is it possible that the workers in the industry sector that gave its name to the recent global crisis, financial activities, have the largest purchasing power increases? One possible explanation comes from the presence of strong government support for the financial sector during the economic downturn. Unlike the non-interventionist approach towards protecting vulnerable workers from falling wages, taxpayer resources were used to spare the financial sector from the contractionary portion of the economic cycle.

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Many economists have expressed surprise over the fact that investment has not been stronger in the recovery from the Great Recession, given the high level of corporate profits. The trends in investment and profits over the last half century suggest that they should not be surprised.

Profit and investment shares of GDP have not moved together over this period. In fact, there is weak negative correlation in shares over this period (-0.3). The figure below shows before- and after-tax shares of profit in net national product (NNP) since 1964.[1] (We use NNP to take account of the fact that the depreciation share of output has increased substantially over this period, which would bias the profit share downward.) It also shows the share of non-residential fixed investment in NNP.

There are several points worth noting about these trends. First, there is not much movement in the non-residential investment share. The table below shows the investment shares of NNP by decade:

Decade Investment Shares
1970s 13.9%
1980s 15.8%
1990s 14.6%
2000s  14.9%
2010-2017(1)  14.3%
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The unemployment rate fell to 4.3 percent in May, a new low for the recovery and the lowest level since 2001. However, this decline in unemployment was the result of people leaving the labor market; as the number reported as employed in the household survey actually fell, with the overall employment-to-population ratio dropping from 60.2 percent in April to 60.0 percent in May.

The establishment survey showed further evidence of a weakening labor market as the pace of job growth slowed to 138,000 in May. There were also substantial downward revisions to the prior two months’ job growth numbers, which brought the average for the last three months to just 121,000.

In addition, wage growth appears to be moderating rather than accelerating. The year-over-year increase in the average hourly wage is just 2.4 percent. Taking the average of the last three months compared with the average of the prior three months, wages are rising at just a 2.2 percent annual rate.

There is certainly little evidence in this report that the labor market is overheating or is likely to do so any time in the foreseeable future.

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While rising capital share and greater concentration of wealth explain some of the story of economic inequality, the largest part of the story is the growth in wage inequality over the last several decades. Available data from the Social Security Administration unfortunately doesn’t go past 1990, overlooking considerable upward distribution of wages beginning in 1980. However, wage distributions from 1990 to 2015 show a clear, and unequal, upward trend.

The share of wages earned by the top 0.1 percent of wage earners increased 36 percent in that time period, from 3.5 percent of all wages earned to 4.8 percent. These earners are largely Wall Street bankers and top executives from private companies, as well as hospitals, universities, and other non-profits. Although the data from such a small pool of workers is erratic, they show soaring gains over ordinary workers that coincide with stock market peaks. Wages at this income level are likely paid in part in stock options, so that connection is unsurprising, but the magnitude of wage increases for this group compared to the others supports the argument that wages are part of the inequality picture.

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On the 17th of this month, a group of House Democrats, including Representative John Delaney (D-MD.), delivered a letter to President Trump offering, essentially, a trade: A tax holiday for international corporations in exchange for the guarantee that the money from that repatriation would be used exclusively to fund the country’s long-overdue infrastructure maintenance projects. Earlier this year Rep. Delaney also authored a tax and infrastructure bill which would allow corporations with funds outside the U.S. to return that money to the country at a tax rate of 8.57 percent (instead of the top corporate tax rate of 35 percent). Delaney, in his statement, called the bill a “pro-growth reform” and his co-sponsor, Rep. Rodney Davis (R-IL), said that it would “spur job creation”.

Unfortunately, the Senate Subcommittee on Investigations has looked into this proposition and it disagrees. In 2011 the committee analyzed the Bush tax holiday (which also promised to increase job growth and boost the economy) and found that it did the exact opposite. Not only did the tax cuts lead to a net decrease in hiring by the companies that took advantage of them (which were almost exclusively in the pharmaceutical and tech industries), the money went predominantly to stocks and executive bonuses rather than new investments. The cuts also cost the Treasury an estimated $3.3 billion in revenue over the subsequent ten years. There’s no reason to think the results of a tax holiday would be any different now, and that lost tax revenue only exacerbates long-term federal funding shortages for infrastructure and other critical projects.

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