The Nursing Shortage

The interplay between supply and demand is the defining characteristic of the free market. When something is desperately needed and in short supply, the price goes up. Ask any diabetic (in the US) about the cost of insulin.

What, then, to make of the nursing shortage?

Much ink has been spilled on outrageous CEO compensation relative to the pay of ordinary mortals. According to Holbert L. Harris, Chair of Economics at George Mason University,

It’s not popular to say, but one reason their pay has gone up so much is that CEOs really have upped their game relative to many other workers in the U.S. economy. (emphasis mine)

If we are to believe this argument (rather than viewing it as the work of a bourgeois apologist), how do we explain the fact that nurses don’t earn enormous salaries?

Healthcare settings can’t run without nurses. Hospitals and nursing homes have had to close beds over the last two years because of a lack of nurses to staff them. The number of nurses has not kept pace with the aging population either, dropping from 69 nurses for every 1,000 people over age 65 in 2003 to 62 in 2021. Twenty percent of working nurses plan to retire in the next five years, so the supply is growing even smaller as demand rises.

If the free market applied to everyone, not just CEO’s, then the fact that nurses have “upped their game” by providing more complex care to more patients should result in significant pay increases. It has not. Administrators lament the cost of travel nurses, but the rising popularity of travel nursing is not a cause of the nurse shortage, but rather, the response of professionals who actually understand their economic power.

Travel nurse pay during the pandemic showed us what nurses are worth in the free market: a great deal more than they get right now as regular employees at hospitals, nursing homes, and clinics across the country.

The suits in administration offices across the country, who use the market to justify their own value in the C-suite, should treat nurses according to the free market principles they invariably hold dear. They should spend their money salaries and benefits that would make travel nursing less attractive than being on staff.

In the dumb show that is late-stage capitalism, though, the power of free-market forces is an illusion --or rather, a rationalization. It makes the 1% feel justified about taking food, shelter, and healthcare from millions. The myth of executive value, couched in the language of merit (upping their game) is just one more excuse for accumulating wealth that an ordinary person could not spend in a thousand lifetimes.

What will happen to health care if pay is truly determined by market forces? Can you imagine a world in which nurses are as well paid and well treated as their training and market value demand? Can you imagine a health care system that prioritizes care over diagnosis –-in which physicians are not the only focus and executives are paid according to their actual value and not their membership in the coterie of the elite?

I don’t have that big an imagination, so my best advice for the future of health care in the United States is this:

Buckle up.