Noam Scheiber

Well, the healthcare industry had been consolidating for a few decades.

But if you remember, one of the big priorities of the Obama administration when it came to power in 2009 was to make the healthcare industry a lot more efficient.

And they did that through big initiatives like Obamacare and through a series of regulations that really accelerated consolidation in the industry.

And there's actually kind of an irony here, because on one level, Obamacare was a more populist economic policy.

It really expands healthcare coverage to millions of Americans who didn't have it.

But on the other hand, it kind of makes healthcare an industry that's worse for the people who are working in it.

Well, one of the wrinkles of Obamacare and these regulations is that they actually foist more risk onto individual hospitals and health care systems.

So, for example, if patients got a procedure and didn't do that well after the procedure, the government might not reimburse the hospitals as much as they were expecting.

And so the hospitals decide that the way to protect themselves against this risk is to get bigger and bigger.

You know, if you're a small hospital and suddenly the administration isn't reimbursing you as much as you thought for different procedures because your patients aren't doing as well as you'd hoped, that can really hurt you financially.

But if you operate dozens and dozens of hospitals, you're much more insulated against that risk.

And what happened when these healthcare systems got really big is they started buying up more and more hospitals in different cities and states.

And that actually created fewer places for people to work.

And this kind of had two effects.

First, if you are a nurse or a pharmacist or someone who worked in the back office of a hospital, that really could have an impact on your wages because you had fewer potential employers bidding up the price of your labor.

And then there was a second set of employees like doctors.

And these folks generally didn't see their wages go down, but they were still affected in other ways that made them really hate this new arrangement of working for bigger and bigger healthcare systems.

So, for example, I first covered a group of doctors who were unionizing at a big healthcare system in Oregon in 2015.

And one thing that I heard from them over and over again is we feel like cogs in some giant medical industrial complex.

We might as well be factory workers.