this post was submitted on 23 May 2026
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So how does it work if I spend 10-20,000 hours in medical school and then spend three minutes setting your broken bone?
It doesn't really matter for this point.
The point is that nobody earns ten million hours (1,140 constant years) of work ($1b @ $100/hr).
You can have a lot of leeway with ratios and that'll still never be true.
Healthcare’s goal should not be to be profitable. The government should subsidize both the education and pay of medical staff for the wellbeing of their people.
Ok, now do any other form of higher education.
Ok, now disconnect the ability to live comfortably from one's labor value.
Sure, but that doesn’t answer the question.
I think you can draw a line somewhere between “everyone’s skills are equally valuable” and “billionaires should exist.”
This metaphor doesn’t address the time required to develop skills.
The line I'm drawing is a wall between the value of your skills and the need to spend time using them just to afford to survive. Then if you choose to develop skills and use them for the benefit of others, it will be because you chose to and not because you felt you had no other choice. The time spent will be your own, for your own reasons and no one else's. Its value will be a value you hold, not relying on the value others perceive it to have.
I've played around with this idea, and the best solution I came up with was amortizing hours spent in training over the course of a career. If you spend 20,000 hours in med school, and you have a projected career of (40 years × 2,000 hours per year) 80,000 hours, one hour of your labor would have a value of 1.25 "unskilled" hours.
Yeah but that doesn't really work because it still treats all the hours as fundamentally equal which just isn't true. It may take someone 20000 hours to become a doctor with a particular skillset, but that doesn't mean ANY person can do that. Person X may never, regardless of investment of time, be able to obtain a mastery of that skillset. Moreover, for things like surgery you're talking about the stacking of hours for regular education, med school, specialty, residency, and then surgery. Each of these is a threshold that increasingly fewer people can cross.
It seems that reasonably the best thing to do is to award additional value based on scarcity and necessity of profession, but you might just back yourself back into capitalism I guess? At the end of the day I can dig a ditch but you can't fix your grandfather's heart so that amortization is not a very satisfying split.
I didn't say it was a particularly good solution. It's definitely more complicated than hour-for-hour.
You did a whoopsy by picking health care as your example, but you’re spot-on. Our ability to develop new skills, learn from experience, and invent new ways of doing things is perhaps the distinguishing feature of human labor over mechanical processes.
This is a decent meme for the world of 15 years ago, but as algorithmic (and now AI) centric labor has taken over and turned us into “chickenized reverse centaurs” (as Cory Doctorow says), I think it accidentally makes the same case that the tech lords are making.
That is: output is output. Artists are valuable for the art they produce, not for being an embodied being in our shared space that specializes in looking at things from new angles. Coders are valuable for the finished software they produce, not for understanding the system in motion. Etc.
Edit: There’s a Marx quote I like…