Out of half an ear (I was washing the dishes, which requires intense concentration, or a working dishwasher) one recent evening, I heard a commercial on CBS for, I think, a tablet computer. What dragged my attention away from the stuff in the sink was the remark that this game-playing machine would tell your game-playing kids when their game-playing time was up for the day, so that — wait for it — "you don't have to." Automation has begun taking over aspects of parenthood.

There are machines that monitor your baby while you are out and send an alert if something goes wrong. Grit-blasting robots clean Australia's Sydney Harbor Bridge, doing the job faster, cheaper and better than the humans they have permanently laid off. Robot painters can create, as well as copy, fine art. Oscar-nominated Stanley Tucci thinks actors are "probably going to be replaced by [machine-generated] digital [actors]."

Roomba robot vacuum cleaner maker iRobot has patented what is essentially a factory purposefully designed for zero employees.

Robots do a better job in the classroom with autistic children today, and it will be all children tomorrow. RoboCop gets real by the minute. Robot résumé readers replace personnel in Personnel. One day, they will review only robot résumés.

These are the proverbial tip of the iceberg. Astounding, don't you think?

Underestimating Underemployment

The 2013 annual report of the World Economic Forum, to me, was also astounding. It was astounding not for what it said, but for what it failed to say even in the light of its own survey data, which showed that "chronic labour market imbalances," defined as "a sustained high level of underemployment and unemployment that is structural rather than cyclical in nature," had a "likelihood" of 3.69 and an "impact" of 3.73 (out of a possible 5). That ranked unemployment and underemployment 11th out of 50 factors in terms of the global impact it would have.

While acknowledging that unemployment and underemployment are pretty important — that there is a relatively high likelihood of their happening and having a great impact — the WEF report barely mentions it except as a variable in its figures and tables. It does note that "particularly interesting cases which had big increases [since 2012] in both likelihood and impact scores are: … chronic labour market imbalances" [emphasis in original]. In fact, the report noted, this was the third fastest-growing factor between 2012 and 2013. But the underlying causes of unemployment and underemployment, and what to do about this potentially devastating, world-changing trend, are not even mentioned.

I have long argued, including in my H&HN Daily columns, that automation and intelligent machines are responsible for much of the joblessness we see persisting even as the recession ends. "Persistence" is probably the wrong descriptor; acceleration in joblessness is the far more likely scenario as machines accelerating in intelligence and autonomy take over the running of factories, distribution systems and offices. In defining the issue as a "sustained" high level of unemployment and underemployment, the WEF may be masking the acceleration of the trend. Understanding the acceleration, it seems to me, is critical to planning effective, efficient and timely intervention.

Institutions and individuals in health care and medicine are not immune to the ravages of automation and intelligent machines. But neither are they denied the benefits; though relative to other industries, they have been slow to avail themselves of them. To be ravaged or benefited: That is the question; but the WEF is silent (at least in its 2013 report) on both counts. Some economists (including, I suspect, many who contributed to the WEF report) independently predict that automation ultimately must lead to a jobless economy and the end of capitalism as we know it.

Unemployment and Capitalism

Capitalism works when people accrue wealth through the interaction of demand and supply for goods and services. The ability to accrue wealth always has been the prime motivator of supply. Labor has been a supply commodity much in demand by capitalists as the means of production of goods and services. At the microeconomic level at which most businesses operate, it makes no difference whether the labor is human or machine, as long as it is maximally productive.

But it makes a huge difference at the macroeconomic level, where governments and very large businesses operate. And when a macroeconomy sneezes, the microeconomies catch a cold or worse. Fewer people have income enough to buy the supply of available goods, even though the cost of those goods may fall dramatically as a result of machine productivity. Therefore, many companies will go out of business or be absorbed into more powerful or efficient companies. Over time, the ownership of the means of production will pass to a handful of people who own the machines.

The problem is that machines are increasingly productive and brilliant at supply, but they don't create demand, do they? If only humans create demand, and if the only humans with the money to demand anything (health care, for example) are a handful of automated factory owners, while the majority of people are out of work and out of the wherewithal to demand anything at all, then clearly the economy will be constrained by lack of demand, not lack of supply. Not to mention riots.

But, in fact, humans are not the only entities that create demand. Machines create demand for more and better machines. Right now, they do it through humans who seem like masters but are, in the long term, mere intermediaries, and eventually the machines will have enough intelligence to demand anything, on their own. They will create an economy, in a sense, or, if we are smart, they will extend the existing economy in a way that benefits both humanity and machinity (if I may coin the term).

In a recent column, I quoted David Bouwman: "The coming of technology is always seen as the coming of the Borg in "Star Trek" — something that threatens to displace humans from our heritage. I don't think we have to worry about that. Being able to do more with machines is going to be the dominant future. I love science fiction, but have sworn off dysfunctional postapocalyptic novels, because I don't think that's the way we are heading. Rather, we are heading toward an enabled, broadened future … ."

I agree, but only as long as we understand the major impacts and take steps to mitigate or (better) to harness their power.

Spreading the Wealth

The only way society can survive will be by equitably distributing the products and profit generated by the prodigious productivity of machines, to everyone, through some welfarelike mechanism. Understanding the accelerating trend of automation and its macroeconomic and sociopolitical ramifications is vital if our institutions, including the institution of health care, are to adapt and survive.

Such seemingly weighty issues as Obamacare — who pays how much, etc. — will pale into insignificance against the bigger looming issue: the end of work. With respect, it seems to me that the World Economic Forum not only has more than enough brain power to examine the issue in depth, but also has more than enough self-interest in maintaining a viable world economy to want to examine it, and soon.

As with global warming, if the theory of global joblessness just might be true but nothing is done to prepare for the possibility, we will end up facing another disaster of global proportions.

David Ellis is a futurist, author, consultant and publisher of Health Futures Digest, a monthly online discursive digest of news and commentary on long-range, leading-edge technological innovations and their consequences and implications for health care policy and practice. He is also a regular contributor to H&HN Daily and a member of Speakers Express.