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Comment by bryanlarsen | Hacker News Reader

Boomer's may have accumulated a large amount of wealth, but that wealth is going to be hit hard by Baumol's cost disease.

Right now the US has ~4 workers per retiree. That's going to be dropping to about 2 in the next few decades. And despite frantic efforts from the Japanese, the services that the elderly need are hard to automate. These services generally suffer from Baumol's cost disease: nursing et al are very 1:1 jobs with or without the help of technology.

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It's weird though - my girlfriend studies nursing and Geriatric Nursing is still one of the lowest paid specialisations with poor conditions and respect (compared to say working in the ICU).

It seems residential homes charge the 'guests' loads and pay the staff (carers, nurses, cleaners etc.) very, very little.

Hopefully not offending anyone, but it is one of the most manual labor intensive and has some of the lowest educational requirements and cognitive overhead of the various nursing specialties. It also carries lower requisite insurance costs.

Also one of the best examples of what you lose in this changing society though. The decline of the middle class in general is of course problematic, but at least some of these jobs weren't worth saving as activities (though probably as careers). However that you can't have sustainable career as a common nurse, teacher or construction worker is a huge problem. Because these professions can't necessarily be paid a lot and also serve the public.

Geriatric may be one of the worst paid of the nursing professions, but nursing itself has seen its salaries increase dramatically. Partially due to demand, partially due to increasing responsibilities, and partially due to the equal pay for equal work movement. I know nurses who make well into 6 figures. That's because they work way more than 40 hours / week, with much of that night shift, but even without it's not the horrible pay it used to to. Nursing is definitely a "sustainable career".

I hope you are correct. Point still stands that professions like nursing to some extent have an inverse relationship between utility and cost. Everyone can't be a nurses with specialist education, a teachers at private school or a construction worker building luxury apartment buildings. If people do not want to pay more, and probably also lose more in transit, I think it is crucial that you can live a good life at low costs in those professions. Otherwise no one is going be left to care for the weak, tech the poor or build housing for the middle class. At least not with good results.

But nursing salaries in general have increased dramatically over the decades. From wages suitable for "unskilled girls" to something that is almost appropriate for the highly skilled professionals that they are.

[1] https://en.wikipedia.org/wiki/Baumol%27s_cost_disease

> Right now the US has ~4 workers per retiree. That's going to be dropping to about 2 in the next few decades.

I think it's more like a 1/3 drop will take 45 years:

https://www.econdataus.com/workers.html

not that it changes your overall point by much.

I sure hope they put their retirement investments into companies that pay their workers enough that society still functions. My bet would be on complaints about how milk is five times as expensive as it was back in the 80s instead.

> nursing et al are very 1:1 jobs with or without the help of technology

How's that? I'm not familiar with the industry at all, but every place I've seen has far fewer nurses than patients. Is there a source on this information? Or some inside information I am unaware of? Or are you just exaggerating by using the term 'very'?

By 1:1 I meant that nurses spend time hands on with patients one at a time.

I see. And so you're saying productivity of the profession is fixed or somewhat limited. Got it, thanks.

Are the services really very hard to automate? It seems a lot of the staff time is spent administering medication, helping patients move around and monitoring. All of these sound amenable to automation within today's state of the art.

> Are the services really very hard to automate?

Absolutely yes. Patients may be frail and suffering cognitive decline that demands compassionate expertise if one is to provide humane care.

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