AUDIE CORNISH, HOST:
The number of health care jobs in the U.S. keeps growing. Take Ohio. Health care positions there now top those in manufacturing. Now, on one hand, those jobs are good for local economies, but on the other hand, analysts say that kind of job growth isn't so great if it's because of the inefficiencies of a complex health care system. NPR's Don Gonyea reports.
DON GONYEA, BYLINE: Just east of downtown Cleveland sits a 160-acre campus of one of the most highly regarded hospitals in the world, the Cleveland Clinic. Toby Cosgrove, the CEO, points skyward to a massive piece of abstract art hanging from the ceiling in the lobby. It looks vaguely heart-shaped.
TOBY COSGROVE: Well, actually it's a model of a iceberg.
COSGROVE: And the reason I like it and I think it's appropriate for health care is there's so much going on behind the scenes that you don't see. For every doctor here, there are 18 employees that are supporting that individual.
GONYEA: Cosgrove talks about the shifting Ohio economy.
COSGROVE: Unfortunately we have lost a lot of the manufacturing, which were great jobs in the United States.
GONYEA: But he also notes the growing health care industry. The Cleveland Clinic alone has more than 50,000 employees nationally, most of them right in northeast Ohio.
COSGROVE: You see people like neurosurgeons on the one end of things.
GONYEA: And the bus drivers who shuttle people around the sprawling campus.
COSGROVE: So it's a wide variety of employment.
GONYEA: And Cosgrove says there's easily an equal number of spinoff jobs, everything from local restaurants to suppliers to housing. Now across town to the smaller public hospital known as the MetroHealth System - it has more than 7,000 employees, but that number is also growing. Derek Dodds has been a respiratory therapist there for 23 years.
DEREK DODDS: You know what? I think I was part of the influx into the health care system because I grew up in Youngstown.
GONYEA: Youngstown is known for its steel mills, nearly all of which are gone now.
DODDS: When I went to college, I was looking for something that would be - that I would be guaranteed to really get a job once I graduated, and the health care field is there.
GONYEA: This hospital's finances have been helped by Medicaid expansion in Ohio, but President Trump and Republicans have proposed big cuts to Medicaid. Dodds says that worries him.
DODDS: Now it's almost like the wild frontier again where you don't know what's going to be happening.
GONYEA: MetroHealth officials say the hospital is on solid financial ground these days. Obamacare has meant more people have insurance, but they've also found cost efficiencies. Many, many health care workers never set foot in a hospital or clinic. Meet 50-year-old Shanese Alexander.
SHANESE ALEXANDER: I go from home to home, taking care of patients.
GONYEA: She does the kind of job that's been one of the fastest growing in recent years.
ALEXANDER: Different things like maybe a little light housekeeping, make them something to eat, making sure that they take their medicine, keep their doctor's appointments and things like that.
GONYEA: She won't say what she's paid, but her union, the Service Employees International Union, is pushing to raise wages to $15 an hour. Alexander agrees that health care overall needs to be more efficient, but she hopes the work she does isn't targeted for cuts.
ALEXANDER: That would mean a lot to people without service. Sometimes we're the only people that they see.
GONYEA: Health care economists say the goal should be to continually find ways to make the industry, with its layers of administrative jobs, more cost effective. Katherine Baicker studies the health care economy at the Harvard School of Public Health. The jobs are great, she says, if...
KATHERINE BAICKER: If we have a lot of people employed in health care because we're delivering a lot of health because people are living longer healthier lives, that's a wonderful thing.
GONYEA: But she stresses it's important to remember these jobs are funded by taxpayer dollars or insurance premiums.
BAICKER: We want people to have jobs, but we want those jobs to be producing a higher standard of living. If we have a lot of people employed in health care in a way that's driving up health insurance premiums and the cost of services but isn't producing health, then we'd be much better off if those people were employed somewhere else.
GONYEA: Compounding this is the reality that the population in places like Ohio is aging, which means more people are going to need more care. That would help justify the jobs, but the industry still has the challenge of delivering services more efficiently. Don Gonyea, NPR News.
(SOUNDBITE OF LAURA GIBSON SONG, "HANDS IN POCKETS") Transcript provided by NPR, Copyright NPR.