People forget that fundamentally, these are services that become relatively more expensive over time (as other things get relatively cheaper). Both healthcare and education don't really benefit from cost-reduction from scaling. At the end of the day, its still one service provider to few service consumers. Productivity in that sense is unchanged in 30 years. Meanwhile, consumer goods can continue to drop precipitiously with technology and scale. As technology improves productivity in other sectors, Net result over time, is that things like healthcare and education and other services which don't scale will continue to get relatively even more expensive (i.e. grow faster than inflation).