The $100,000,000,000 Problem

This is the first entry in a three-part series about the past, present, and future of social and medical service referral in the United States.

The social safety net is inefficient and ineffective. Admittedly, that’s not a particularly novel or actionable observation, but did you know that the United States spends more than $100 billion every year just in the time it takes to connect people in need with social and medical services?1 (That doesn’t include the cost of actually providing such services.) To put this into perspective, for about $100 billion, the United States could pursue a wide variety of notable programs.2

Johego | What Can $100B/yr Buy

It’s actually worse than that. The $100 billion figure cited above includes only professionals in the social service, healthcare, and education sectors: it does not include social and medical service referrals made by police officers, firefighters, attorneys, and other public service professionals not included in our survey. Moreover, it does not fully capture referral-related administrative duplication that exists across these sectors.

Because there does not yet exist a sufficiently comprehensive and reliable directory of social and medical services, public service professionals must rely on word of mouth recommendations, online search engines, and printed paper directories as primary sources of information.3 Such inefficacy is harmful to those in need and those who serve them: a feeling of professional inefficacy is one of three primary dimensions of burnout, a widespread occurrence among nurses and social workers. As a result, many nonprofits create their own in-house directories, resulting in significant duplication of administrative efforts. Benetech, a MacArthur Genius-led nonprofit technology company, studied eleven such directories in and near the San Francisco Bay Area. Here is what they found:

Benetech Service Net Analysis Benetech Service Net Analysis

Meanwhile, despite tremendous investments of time, talent, and treasure, many are struggling. Over one in five American children live in poverty, over 21 million Americans experience addiction, and over half a million Americans are homeless.

Why hasn’t this been solved? Various groups (such as 2-1-1, Aunt Bertha, and Healthify) have attempted to collect and share information about social and medical services. However, maintaining large or detailed directories is technically challenging and expensive: fundamentally, the only way to reliably verify information about a service provider is by asking them directly, typically via a phone call. Benetech estimates that it costs as much as $140 to collect information about just one service provider. Freely shared information faces free-rider pressures, and paywalled information competes with “free” resources previously mentioned: word-of-mouth recommendations, online search engines, and printed paper directories.

The good news is that it doesn’t have to be this way. In our next post, we will describe how Johego has designed, developed, and validated at scale an innovative data pipeline for collecting and verifying information about social and medical services — one that is reducing the time required to make service referrals as well as the need for creating in-house directories. Until our next post, if you want to know more about our work, you can follow us on social media or sign up for our email newsletter:


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As always, thank you for your support!

– Michael

Sources & Calculations:

1.) $100B+/yr Referrals. In 2017, Johego surveyed 24 professionals from the social service, healthcare, and education sectors who, as a regular or occasional part of their work, refer people to social and medical services. We asked them to report the number of people they typically refer to social and medical services each week as well as how much time they typically spend making such referrals. The following is a summary of their responses:

Sectorn = 24People/WeekHours/Week
Community and Social Services11126.5

Then, using Bureau of Labor Statistics data, we determined the number of professionals in each sector as well as the median wage of professions within each sector, as follows:

CategoryOccupationCountMedian Wage
Community & Social ServicesSocial Workers649,300$22.07
Health Educators and Community Health Workers115,700$21.08
Mental Health Counselors and Marriage and Family Therapists168,200$20.77
Probation Officers and Correctional Treatment Specialists91,700$23.73
Rehabilitation Counselors120,100$16.54
School and Career Counselors273,400$25.8
Social and Human Service Assistants386,600$14.82
Substance Abuse and Behavioral Disorder Counselors94,900$19.22
Social and Community Service Managers138,500$30.54
Childcare Workers1,260,600$9.77
Personal Care Aides1,768,400$10.09
EducationPreschool Teachers441,000$13.74
Preschool and Childcare Center Directors64,000$21.96
Kindergarten and Elementary School Teachers1,517,400$26.23
Middle School Teachers627,500$26.86
High School Teachers961,600$27.5
Postsecondary Teachers1,313,000$34.84
Postsecondary Education Administrators175,100$42.59
Special Education Teachers450,700$27.31
Instructional Coordinators151,100$29.94
Career and Technical Education Teachers231,800$25.38
Adult Literacy and High School Equivalency Diploma Teachers77,500$24.17
Teacher Assistants1,234,100$11.97
Library Technicians and Assistants210,700$13.43
HealthcareMedical and Health Services Managers333,000$45.43
EMTs and Paramedics241,200$15.38
Home Health Aides348,400$10.54
Licensed Practical and Licensed Vocational Nurses719,900$20.76
Medical Assistants591,300$14.71
Medical Records and Health Information Technicians188,600$17.84
Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners170,400$50.36
Nursing Assistants and Orderlies1,545,200$12.36
Physician Assistants94,400$47.2
Physicians and Surgeons708,300$90.
Psychiatric Technicians and Aides145,200$13.61
Recreational Therapists18,600$22.06
Registered Nurses2,751,000$32.45
TotalPublic Service Professionals20,569,750

With such information, we were able to estimate the total number of professionals in each sector as well as the average median wage within each sector. Then, assuming that our survey respondents are typical of their sectors, we calculated the total baseline wages required for social and medical referrals made each year. Finally, we multiplied the total baseline wages required by 1.4 to account for benefits, payroll taxes, and general organizational expenses associated with such labor.

2.) $100B+/yr Equivalent. The Marshall Plan cost ~$103 billion over four years (~$26B/yr). The Apollo Space Program cost ~$107 billion over twelve years (~$9B/yr). Providing improved water and sanitation throughout the globe would cost ~$23B/yr. Eliminating homelessness in the United States would cost ~$5B/yr. Doubling federal expenditures on academic research and development (R&D) would cost ~$39B/yr. Taken together, pursuing these programs would cost ~$102B/yr, which is ~$4B/yr less than our conservative estimate of the annual cost of social and medical service referrals in the United States.

3.) Referral Sources. In 2017, Johego surveyed 24 professionals from the social service, healthcare, and education sectors who, as a regular or occasional part of their work, refer people to social and medical services. When asked to identify the primary source(s) of information for completing such referrals, 21 respondents (88%) selected word-of-mouth recommendations, 18 respondents (75%) selected online search engines (e.g. Google), and 14 respondents (58%) selected printed paper directories. These were the three most commonly selected categories.

In order to better inform the public about some of the difficulties involved with navigating the social safety net, we are collecting stories from people who, in their personal or professional capacity, have struggled to connect themselves or a friend, family member, or colleague with social or medical services. If you have a story you can share, we would like to hear from you!

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