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

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)

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-...

* https://archive.is/https://www.noahpinion.blog/p/insurance-c...

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).

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.

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.

> Also in 1798, Congress passed the Sedition Act, which violated the First Amendment. The simple fact that a Congress included many Founders does not necessarily imply that its acts were all in compliance with the Constitution those same Founders wrote or concurred with years before.

Or they were not 'absolutists' in regards to the Constitution they themselves wrote, and understood some play / slop was needed in interpretation and implementation.

Yup. There are numerous examples of the founders passing laws that appear to directly contradict the constitution. The Coast Guard traces its enforcement authority to the Revenue Service Act of 1790, which allows US officers unfettered access to vessels in US waters without a warrant. This law has been consistently upheld because judges make the lazy argument that, since it was passed by the same Congress that wrote the 4th amendment, it’s obviously compatible with the 4th amendment.

A far more likely explanation is that it was a new government based on a new constitution and everyone was still figuring out how it all worked and, in the process, they made some mistakes. Now we’re stuck with bad laws because of founder worship. The founders weren’t perfect and they didn’t create a perfect system. It’s time we stopped acting like they did.