Healthcare Will Not Save The U.S. Economy
Aging Population Aside
Below is easily one of the most underappreciated charts in all of macro because it perfectly exemplifies the “growth” we’re experiencing in healthcare current day and has far reaching implications beyond a single disorder.
Board certified behavior analysts (BCBA) treat a variety ailments- Autism (ASD) just so happens to be at the top of the list. And the amount of growth these clinicians have experienced over the past decade in particular is nothing short of astronomical.
Obviously growth is slowing as of late- still near 10% Y/Y though….
But they’re not the only ones on the upswing as they supervise registered behavior technicians (RBTs), which is a certification created in 2014 by the same licensing board for BCBAs. Conveniently, the DSMV-5 was released a year prior in 2013, which generally widened diagnostic guidelines around things like autism. More on that in a minute.
Current day, RBTs outnumber BCBAs 3 to 1 which makes perfect sense from a cost/care coordination standpoint. At least in theory.
Plus, RBTs are low earners that tend to be younger, prime working age women. And that might seem like a meaningless observation to the uninitiated, but recall employment for healthcare and social assistance combined is ~79% female regardless of occupation.
**Note that BCBA-Ds and BCaBAs represent a meager 2% of all related certifications** as of 2025.
And just so we’re clear, I’m not interested in some pointless debate challenging the validity of ASD, how and where it’s treated, related comorbidities such as ADHD, why it generally impacts boys more than girls, or how the diagnoses age among certain cohorts has been climbing as of late. After all, I’m no clinician.
But what I can tell you is that a growing segment of these individuals get captured in the Medicaid population where utilization guardrails are somewhat open to interpretation. And Medicaid tends to be a reliable payer, sometimes too reliable one might suggest. Just ask California and Minnesota!
More importantly, these are signs of a much larger trend in healthcare where low cost care is of utmost importance.
So when I hear folks say things like “Nothing Stops this Train!”, to me that’s a lazy analysis, because:
the bulk of employment post COVID is being driven by healthcare and its close cousin social assistance (which are usually reported together); and
low level clinicians like RBTs, social workers etc. who barely make enough to afford ramen are said drivers; and
women are already participating in the workforce at elevated rates across the country….
So…..incomes stop this train.
That is unless UBI goes mainstream- AI seems like the perfect excuse justify handouts, am I right? At this point, our current administration is not even hiding the debauchery. Not a political statement- both sides are terrible.
That said, let me show you why such a small segment of healthcare workers such as RBTs and the like matter to the big picture. Most of this stuff is not on the average person’s radar unless they look at national provider identification (NPI) records etc routinely.
NPI’s you say?
Allow me to explain
NPIs are 10 digit unique identifiers assigned to individual providers across the spectrum of care like MDs and even therapists (type 1 NPIs); as well as organizations (type 2 NPIs).
