Health Care Workforce

WM Health: Advancing the Next Generation of America’s Health Care Workforce, February 24, 2026

These comments reflect my experience staffing the H1-B technical skills training program, as proposal coordinator for Graduate School, USA and as the author of The Future is Calling: It Wants a Better Job, which dealt with medical education as one of its topics. As I commented in February 2025, the healthiest option is for employee-owned companies to train and hire their own doctors. This would assure good service to all communities, especially rural and underserved ones. In a cooperative setting, no one is underserved.

In meeting healthcare staffing needs, we must guard against forcing underskilled workers to participate, especially those receiving public assistance. In a 2002 GAO Report, High-Skill Training: Grants from H-1B Visa Fees Meet Specific Workforce Needs, but at Varying Skill Levels, GAO-02-881, Sep 20, 2002, from Bruce Mehlman, the Assistant Secretary for Technology Policy at the Department of Commerce,  noted that legislation mandated information technology, as well as other high skill training, yet the Department of Labor channeled a significant portion of training resources into training nursing assistants.  

In 2011, Graduate School USA applied for and received major grant funding to teach nursing assistants and phlebotomists to TANF recipients.  My alma mater, Loras College, recently established a similar program for non-degree individuals. Using low-skill medical job training as the “go to” program for welfare reform is cynical.  Some of us in “the Movement” see directing poor people into service occupations as more of the same class and income segregation we hoped we would have grown out of by now.

Any person who has been underserved in their youth, or who has entered the nation in pursuit of a new life, must be provided remedial education to the level promised by our national social contract. At a minimum, all are entitled to literacy at the tenth grade level and to be paid to attend this training to compensate them for the opportunity cost incurred because attending such training makes other employment impossible.

Only after this level of training is completed can they make an informed decision on advanced technical or academic education. One such path could very well be in health care, but it must not be the only path. If such jobs are required by society, then payment must be high enough to make such a career attractive to them.

When I was assisting DOL in administering training programs, many health programs offered a career ladder to LPN - although the grant started with low level nursing assistant and phlebotomy training. The career ladder must go higher. For qualified candidates who have attained literacy first, the path can be extended upward to a four year degree, with optional pre-med courses such as organic chemistry (although many doctors say that this course is simply a hurdle to weed out students rather than a career requirement), leading at first to registered nursing and physician’s assistants degrees. The next step can be nurse practitioner. 

To get more people into nursing, their tuition and living expenses could be paid for with funds raised by state and federal level subtraction value added taxes (which would also fund remedial training as well as both public and private schools from pre-K to 10th grade). Another measure to encourage nursing as part of a career path is requiring medical students to first be nurses, with work hours and class loads which allow for a life outside the hospital and end the need to take out student loans.

For the sake of fairness, nurses and doctors (indeed all college graduates) student loans must be written down to the original loan amount, forgiving capitalized interest in the future and refunding what has been paid over that amount - which would eliminate debt entirely for many.

These incentives will allow doctors to serve rural and underserved areas, as they would not have to seek higher urban salaries to pay back crushing debt.

These incentives will require more nursing and medical educators. As an incentive, those who take on such roles should be rewarded with refunds for all student loans paid in the past, which is essential for fairness to those who graduated years ago and whose experience should be tapped in the training of new professionals.

Attachment: Consumption Taxes