Comment by kingludite | Hacker News Reader

Comment by kingludite | Hacker News Reader

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I don´t know much about nursing specifically but it is actually interesting to account for how many customers served per employee and how many there are at the bottom of the organization. If you are earning next to nothing and are doing 200 widgets per minute a 10 fold salary increase wouldn't change the cost of the product per customer. If there also is a large profit margin the desire to keep wages down is more of a fetish than the sensible choice it is at the other end of the spectrum.

Depending on the type of job you also get a different "product" depending on how much you pay and you might not be able to measure it. Employees cut corners in the least visible way and do not brag about extra effort if they are paid well enough.

This[0] was a fun read.

>Nursing care services are the most intensely used hospital services by acute hospital inpatients yet are poorly economically measured [...] >Nurses are an anomaly in the current inpatient billing system. Rather than bill for the actual services provided to the patient or the amount of time spent providing nursing care, the cost of nursing is embedded into the line item for room and board, which is the same fixed cost for every patient receiving the same level of care within a particular institution. In other words, all patients cared for on a given unit are billed the same room and board charge regardless of the actual amount of nursing care the patient utilized during that hospitalization.

[0] - http://frogfind.com/read.php?a=https://www.ncbi.nlm.nih.gov/...

> If you are earning next to nothing and are doing 200 widgets per minute a 10 fold salary increase wouldn't change the cost of the product per customer. If there also is a large profit margin the desire to keep wages down is more of a fetish than the sensible choice it is at the other end of the spectrum.

It depends on what portion of the cost of production is materials vs capital costs vs labor. You're presuming that labor is a small portion of the cost of production, which is probably true if you're selling them for $10. If it's an extremely low cost item, like plastic washers, labor can still be a significant part of the production costs. It also depends on whether you carry that down the supply chain, since part of your material cost is someone else's labor costs.

> Nursing care services are the most intensely used hospital services by acute hospital inpatients yet are poorly economically measured

This doesn't strike me as utterly insane. Most treatment prices should include the cost to have a nurse deliver it. The tiers of rooms should roughly approximate the amount of nursing care required outside of treatments. It's not perfect, but it might be better on the net than having nurses spend more time on the patient chart to add billing items.

I.e. it might be overall better to not have a specific line item for "rolled patient over to prevent sores" that the nurse has to enter in, and then billing has to argue with insurance about whether a roll was needed or not. It might be cheaper for everyone to figure out the average cost of providing nursing per tier, add a profit margin, and charge everyone that.

I'm not saying it is better, but it seems at least plausible.

> If there also is a large profit margin the desire to keep wages down is more of a fetish than the sensible choice it is at the other end of the spectrum.

I'm consistently surprised by misunderstandings of supply and demand.

There is a labor market. It's relatively free, all things considered. Sometimes companies conspire to keep prices down (see: high tech antitrust lawsuit/settlement) but usually the thing that keeps wages low isn't business owner collusion it's the availability of workers accepting work with a low wage.

Sure, all things being equal business owners would like to pay less for labor. They'd also like to pay less rent, less for insurance, lower taxes, etc. And sometimes they want to pay less than anyone is willing to accept, and sometimes instead of raising wages they rant about it on Twitter or in opinion pieces or whatever.

But that doesn't get them employees!

>usually the thing that keeps wages low isn't business owner collusion it's the availability of workers accepting work with a low wage.

But if you have a labor shortage and low wages at the same time, that means that workers accepting work with a low wage aren't available, but the employers are keeping wages low anyway. (And in this context, poor working conditions amount to "low wages" because they decrease the value of the job to the employee.)

In capitalism, "labor shortage" means "the employers had better pay their employees more, or else they won't have the employees to compete against other employers who will pay more".

I don't think we disagree, but what you describe is not necessarily a result of collusion -- maybe the business just doesn't work with higher-paid workers (i.e., product costs more than market is willing to pay) and scales with number of workers, in which case the owner might take whatever workers they can get at cost X, but can't hire any at cost X+1.

Only a profit-averse business owner would turn away revenue-exceeding-costs work merely because it involves paying workers more -- that business will likely not last super long unless there are special circumstances in play.

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