While the growth of health care costs has slowed over the past few years, lowering costs over the long term will depend on improving health care labor productivity. Over half of the $2.6 trillion spent on health care in the United States in 2010 was wages for health care workers, and labor productivity has historically worsened at a rate of 0.6% per year. Simultaneously, the individual mandate, subsidized coverage, and Medicaid expansion in the Affordable Care Act (ACA), along with an aging population, will drive up the demand for health care. Reducing the rate at which health care costs grow, and the proportion of U. S. gross domestic product and public sector budgets that are consumed by health care over the long term, therefore, will require either increasing labor productivity or substantially lowering workforce salaries. The early signs are worrisome. With health care viewed as a jobs source and jobs being added faster than demand is growing, we appear to be on a path toward more workers and lower salaries, not necessarily more productivity, unless something changes dramatically.