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Big question - why doesn't 1% tax cut it any longer? Today's workers are definitely not sicker than those in the XVIII century because workplace safety standard

Big question - why doesn't 1% tax cut it any longer? Today's workers are definitely not sicker than those in the XVIII century because workplace safety standards, and understanding of diseases themselves, is so much better. Is it that expectations of care are much higher? Or just that the workers are a lot older?

agumonkey 1y ago
The nature of health care changed I guess. Infrastructure, devices.. and even medical research were probably very small and rare ?
owenthejumper 1y ago
Expectations of care are higher, treatments are much more specialized, and therefore more expensive. More importantly, as a commercial system, the pockets of UHG and others need to be lined up much more. (It is a common misnomer that doctors are expensive. Their cost is nothing compared to the overall admin costs)
- loloquwowndueo 1y ago
  Misconception, not misnomer.
throw0101c 1y ago
Profit-motivated (above all else) health care? When that health insurance CEO got shot, there was a lot of venting about health insurance companies and their practices, but much less about the practices of the health care providers. Noah Smith argued that the latter should be considered the main 'villain': > This means that eliminating all administrative waste and inefficiency in the entire U.S. health care system — not just at insurance companies, but administration of government insurance programs — could save Americans at most about $680 per person every year, and probably not anywhere close to that amount.[3] A few hundred bucks a year is not nothing, but it’s only a small fraction of the $5683 more that we pay relative to other countries. > So the fundamental reason your health care costs so much is not that the health insurance companies are lining their pockets. And it’s not that insurers are an inefficient mess. It’s that the actual provision of America’s health care itself just costs way too much in the first place. * https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://www.noahpinion.blog/p/insurance-companies-arent-the-... * https://archive.is/https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://archive.is/https://www.noahpinion.blog/p/insurance-c...
- tough 1y ago
  It's an overall perverse system of incentives which makes every part evil. Putting it only on one party seems off to me.
- koolba 1y ago
  > ... but much less about the practices of the health care providers. > Noah Smith argued that the latter should be considered the main 'villain': Health care providers are like concert venues that outsource jerk-as-a-service to Ticket Master.
- rayiner 1y ago
  Go get a quote for how expensive it is to have your locks handyman install new countertops. Now project that into workers who have a lot more education and need to use very expensive equipment to do their jobs. It’s not “profit motive.” Labor is expensive in a first world country.
  - ty6853 1y ago
    It's even more expensive when the government regulates it to hell and back, intertwines itself with insurance industry, and has an incestuous relationship with the AMA resulting in massively fewer number of doctors than would like to go through the education. And then those same doctors, who are usually on the same professional board as say PAs, use their leverage as a hammer against other high level practitioners to ensure they don't lose a handle on their racket.
- gruez 1y ago
  >Profit-motivated (above all else) health care? That's an incomplete explanation at best. Most things in the economy are "profit motivated" yet aren't dumpster fire that health care is.
  - poncho_romero 1y ago
    But healthcare is a captive market. People will pay whatever is necessary for life saving treatment. That’s not the case with, say, buying a new couch. If couches are too expensive, people will find alternative places to sit or forgo having a seat altogether. No diabetic can say no to insulin, so the market forces that produce sane prices elsewhere in the economy vanish in healthcare
koolba 1y ago
It's a charitable interpretation but there's a lot of specifics at play here. The tax was not 1%. It was defined as a fixed 20-cents per person, not a percentage of income. The wording of the law was that the US government would use the funds for health care for the seaman and any surpluses for building hospitals and related facilities. It had no open ended mandate to provide coverage beyond the sums collected. It could be argued that maritime commerce, by its very nature, is a Federal jurisdiction, thus operating within the Federal governments power (in contrast to the rest of us landlubbers).
w10-1 1y ago
The 1% roughly corresponds to a few ER's at concentrated sites where sailors can first seek care, where the main cost is provider salaries. State of the art then, but not comparable. Also I suspect the main goal was to displace anger about working conditions and get the distressed sailors out of the hair of ship owners and captains, likely prompted by the need to isolate society from infectious diseases and horrifying cripples. I.e., the goal was to contain the damage from the sailors to the shipping business and society, not to protect the sailors.
sophacles 1y ago
In 1798 you were about 100 years before doctors decided that "wash your hands" was solid practice... germ theory itself was considered a bit fringe (and tbf there was a lot of evidence still left to gather to link microorganisms to illness). A huge number of ailments mysterious and attempts to cure them -things like blood letting and mercury potions - were ineffective or even counter productive, that is to say a lot of medicine then was just waiting to see if you got better while having people make sure you didn't die of fever and got some nutrition. The odds of dying from an injury or illness were much, much higher than they are today for any injury or illness, although even then the odds of dying went down if you went to the primitive hospital. So expectations of care are higher, but that might be better stated as "effectiveness of care", since the cost of effective care is generally higher than that of nonsense. "medicine" that is just a slurry of alcohol, cocaine, opium and some random herbs for flavor is much cheaper than a precisely measured dose containing X micgorgrams of of a highly refined, synthesized ingredient. Another factor here is that the insurance only covered the worker themself, not dependents. A sailor with the good insurance has a kid get sick? That sucks, hope they can afford the doctor out of pocket. So in that sense the expectations of care are much higher. Speaking of children - the infant/childhood mortalitry rate was appalling, somewhere between 1/4 and 1/2 of children died. A lot of people were disabled early in life by disease and injury. It took good health and quite a bit of luck to survive long enough to become a sailor - the population that was sailors would be relatively healthy to begin with, making the costs of medical intervention average lower. Related, since this only covered active sailors, old folks and all the ailments of aging weren't factored into the costs. Similar to the previous point - first aid, emergency care, and transportation have improved dramatically. If you get injured in the middle of the ocean and can't survive a week to a month in a dirty ship with diseased crew, you don't contribute to the costs. In 1798 if your hand gets ripped off by some accident or another, they aren't remotely capable of getting you to help without pointing the ship in the direction of a city with a hospital and waiting for the wind to get you there in a few days or weeks - no medevac, no coast guard, not even calling for first aid advice. Even if people then had expectations to match modern ones about a reasonable attempts to provide care - the capability of the times was such that a huge number of people would die long before care could provided at a hospital. So, insurance costs were much lower because a huge number of payees would never survive to take advantage of the benefits they paid for. (Heck, scurvy was still a major problem in ocean voyages, and a large number of the crew of any ship could/would die on a voyage - all of whom paid for the insurance. Limes had yet to be discovered or something). All of this of course is in light of modern views of pricing and salary - which itself is a pretty hard comparrison. In general most of a person's pay went to food up to 90% (or more) - leaving little room for anything else, and so prices and margins (and expectations thereof) for non-food were much different. For the most part in the US food is a much, much lower percentage of a person's expenses anymore, so it's hard to do a direct comparrison.

agumonkey 1y ago

The nature of health care changed I guess. Infrastructure, devices.. and even medical research were probably very small and rare ?

owenthejumper 1y ago

Expectations of care are higher, treatments are much more specialized, and therefore more expensive. More importantly, as a commercial system, the pockets of UHG and others need to be lined up much more. (It is a common misnomer that doctors are expensive. Their cost is nothing compared to the overall admin costs)

loloquwowndueo 1y ago
Misconception, not misnomer.

throw0101c 1y ago

Profit-motivated (above all else) health care? When that health insurance CEO got shot, there was a lot of venting about health insurance companies and their practices, but much less about the practices of the health care providers. Noah Smith argued that the latter should be considered the main 'villain': > This means that eliminating all administrative waste and inefficiency in the entire U.S. health care system — not just at insurance companies, but administration of government insurance programs — could save Americans at most about $680 per person every year, and probably not anywhere close to that amount.[3] A few hundred bucks a year is not nothing, but it’s only a small fraction of the $5683 more that we pay relative to other countries. > So the fundamental reason your health care costs so much is not that the health insurance companies are lining their pockets. And it’s not that insurers are an inefficient mess. It’s that the actual provision of America’s health care itself just costs way too much in the first place. * https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://www.noahpinion.blog/p/insurance-companies-arent-the-... * https://archive.is/https://www.noahpinion.blog/p/insurance-companies-arent-the-main https://archive.is/https://www.noahpinion.blog/p/insurance-c...

tough 1y ago
It's an overall perverse system of incentives which makes every part evil. Putting it only on one party seems off to me.
koolba 1y ago
> ... but much less about the practices of the health care providers. > Noah Smith argued that the latter should be considered the main 'villain': Health care providers are like concert venues that outsource jerk-as-a-service to Ticket Master.
rayiner 1y ago
Go get a quote for how expensive it is to have your locks handyman install new countertops. Now project that into workers who have a lot more education and need to use very expensive equipment to do their jobs. It’s not “profit motive.” Labor is expensive in a first world country.
- ty6853 1y ago
  It's even more expensive when the government regulates it to hell and back, intertwines itself with insurance industry, and has an incestuous relationship with the AMA resulting in massively fewer number of doctors than would like to go through the education. And then those same doctors, who are usually on the same professional board as say PAs, use their leverage as a hammer against other high level practitioners to ensure they don't lose a handle on their racket.
gruez 1y ago
>Profit-motivated (above all else) health care? That's an incomplete explanation at best. Most things in the economy are "profit motivated" yet aren't dumpster fire that health care is.
- poncho_romero 1y ago
  But healthcare is a captive market. People will pay whatever is necessary for life saving treatment. That’s not the case with, say, buying a new couch. If couches are too expensive, people will find alternative places to sit or forgo having a seat altogether. No diabetic can say no to insulin, so the market forces that produce sane prices elsewhere in the economy vanish in healthcare

koolba 1y ago

It's a charitable interpretation but there's a lot of specifics at play here. The tax was not 1%. It was defined as a fixed 20-cents per person, not a percentage of income. The wording of the law was that the US government would use the funds for health care for the seaman and any surpluses for building hospitals and related facilities. It had no open ended mandate to provide coverage beyond the sums collected. It could be argued that maritime commerce, by its very nature, is a Federal jurisdiction, thus operating within the Federal governments power (in contrast to the rest of us landlubbers).

w10-1 1y ago

The 1% roughly corresponds to a few ER's at concentrated sites where sailors can first seek care, where the main cost is provider salaries. State of the art then, but not comparable. Also I suspect the main goal was to displace anger about working conditions and get the distressed sailors out of the hair of ship owners and captains, likely prompted by the need to isolate society from infectious diseases and horrifying cripples. I.e., the goal was to contain the damage from the sailors to the shipping business and society, not to protect the sailors.

sophacles 1y ago

In 1798 you were about 100 years before doctors decided that "wash your hands" was solid practice... germ theory itself was considered a bit fringe (and tbf there was a lot of evidence still left to gather to link microorganisms to illness). A huge number of ailments mysterious and attempts to cure them -things like blood letting and mercury potions - were ineffective or even counter productive, that is to say a lot of medicine then was just waiting to see if you got better while having people make sure you didn't die of fever and got some nutrition. The odds of dying from an injury or illness were much, much higher than they are today for any injury or illness, although even then the odds of dying went down if you went to the primitive hospital. So expectations of care are higher, but that might be better stated as "effectiveness of care", since the cost of effective care is generally higher than that of nonsense. "medicine" that is just a slurry of alcohol, cocaine, opium and some random herbs for flavor is much cheaper than a precisely measured dose containing X micgorgrams of of a highly refined, synthesized ingredient. Another factor here is that the insurance only covered the worker themself, not dependents. A sailor with the good insurance has a kid get sick? That sucks, hope they can afford the doctor out of pocket. So in that sense the expectations of care are much higher. Speaking of children - the infant/childhood mortalitry rate was appalling, somewhere between 1/4 and 1/2 of children died. A lot of people were disabled early in life by disease and injury. It took good health and quite a bit of luck to survive long enough to become a sailor - the population that was sailors would be relatively healthy to begin with, making the costs of medical intervention average lower. Related, since this only covered active sailors, old folks and all the ailments of aging weren't factored into the costs. Similar to the previous point - first aid, emergency care, and transportation have improved dramatically. If you get injured in the middle of the ocean and can't survive a week to a month in a dirty ship with diseased crew, you don't contribute to the costs. In 1798 if your hand gets ripped off by some accident or another, they aren't remotely capable of getting you to help without pointing the ship in the direction of a city with a hospital and waiting for the wind to get you there in a few days or weeks - no medevac, no coast guard, not even calling for first aid advice. Even if people then had expectations to match modern ones about a reasonable attempts to provide care - the capability of the times was such that a huge number of people would die long before care could provided at a hospital. So, insurance costs were much lower because a huge number of payees would never survive to take advantage of the benefits they paid for. (Heck, scurvy was still a major problem in ocean voyages, and a large number of the crew of any ship could/would die on a voyage - all of whom paid for the insurance. Limes had yet to be discovered or something). All of this of course is in light of modern views of pricing and salary - which itself is a pretty hard comparrison. In general most of a person's pay went to food up to 90% (or more) - leaving little room for anything else, and so prices and margins (and expectations thereof) for non-food were much different. For the most part in the US food is a much, much lower percentage of a person's expenses anymore, so it's hard to do a direct comparrison.