I've just had the unpleasant (!) news that I'm going to have to pay over $3,500 up front for two medical examinations, one involving nuclear medicine (to compare the function of my kidneys) and the other a CT scan of their current physical state. Of course, it's the new year, and whereas last year I paid my entire deductible in the first half of the year (plus some charges my insurance wouldn't cover), and thus had a "free ride" for the second half of the year, we're back at square one for 2025. Very fortunately, my wife and I have been saving our shekels for this, knowing it was coming. Even so, it's a big hit, and we'll have to pay twice that before I hit my maximum deductible this year. That's bound to happen.
However, I also have to admit that despite medical costs being (seemingly) very high in this country, there are valid reasons for that. DiveMedic addresses some of them.
This woman here had a child that was born prematurely. That child spent a month in the Neonatal Intensive Care Unit (NICU). The bill came to $738,360, and the mother complains that the cost is too high. There are many in the comments that agree, and it’s filled with comments about how other countries have free healthcare, which is of course false.
The bill for that child’s care is completely reasonable. Let me explain why:
Nurses work 3, 12 hour shifts per week, and NICU nurses are frequently on 1:1 care, meaning one nurse to one patient. A 30 day stay in the NICU means that your child had the undivided attention of 5 nurses for a month. An experienced nurse, (for obvious reasons NICU nurses tend to be fairly experienced, qualified, competent, and educated) aren’t cheap. The average pay for a NICU nurse in the US is about $130,000 a year. Night shift makes even more, thanks to shift differentials.
The nurses in charge of your child’s care cost the hospital $70,000 in direct compensation, plus the costs of insurance, training, and other HR expenses. In all, just the nursing care for that month in the hospital cost that hospital about $140,000. Now add in the costs of everyone involved in that from the doctors to the lab technicians, and even the janitors.
Each of those people is highly educated, even the janitor. Yes, the janitor. To comply with Federal law, that janitor has to be instructed on CPR, stroke procedures, HIPAA compliance, Medicare and Medicaid laws, sex trafficking, recognizing child abuse, disposing of medical waste, and a host of other laws. He also needs to be background and possibly drug checked, especially to work in a pediatric wing. All of this raises the cost of hiring that janitor.
Back to the nurses. It takes 3 years of schooling to become a registered nurse. Then it takes years of experience, training, and work to specialize as a NICU nurse. In all, the average NICU nurse has been a nurse for 5 years or more and has attended far more schooling than a beginning nurse. Pediatrics is a specialty. So is neonatology, as is critical care. NICU nurses have to certify as all three. That’s why they make what they make- competence costs money.
Then there is the lab work, the cost of provider that supervises those NICU nurses (usually a nurse practitioner), lab technicians, respiratory therapists, medications, medical equipment, supplies, meals, and even the guy that empties the trash. Then there are the doctors, as well as the regulatory costs of compliance.
In total, labor costs alone for that stay were probably in the neighborhood of $300,000, so I don’t think $700k is out of line once you do the math.
That isn’t even considering what procedures may have been done- if surgery was involved, you can also add anesthesia, scrub nurses, surgical nurses, and a host of other specialties and specialized equipment.
There's more at the link.
DiveMedic acknowledges that in many countries with so-called "free" or "public" health care, these costs are never seen by the patient: but that's because they're paid by taxpayers in general. Whether the patient pays them directly or pays a wodge of extra taxes to subsidize them, she's going to pay, one way or the other. "Free" healthcare isn't.
That's why I can't complain too hard about having to pay close to five figures last year in insurance deductibles, plus pretty much the same again in costs not covered by insurance. At least I live in a country where the medical system is good enough to treat me, and advanced enough to offer the latest technology, and I don't have to wait forever to see a doctor who may or may not be competent! I can certainly understand the frustration of those who need treatment but can't afford it, but even there, many hospitals offer arrangements whereby they take the financial hit and offset it against their taxes as a charitable donation. Other generous individuals donate to help cover the cost of expensive procedures (as one reader, who wishes to remain anonymous, did for me last year - for which my eternal gratitude!). There are ways.
These two examinations, later this month, will determine whether I need further kidney procedures (up to and including losing a kidney if things don't look good). I'm hoping and praying for the best. Thereafter, as soon as the kidney situation is dealt with, I have to look at further spinal fusions near the site of my existing one. After 21 years, that area of the spine is showing the strain, and needs reinforcement. That's going to be very painful and very expensive, I suspect . . . but we'll see. Again, thanks be to God that I live in a country where such advanced care is available! I shudder to think what the fusion procedure might be if I still lived in Africa. It would probably involve baling wire and strips of rubber tire!
Peter
15 comments:
My retired neighbor is actively working to move to Italy, partly for the "free" healthcare. I always interject "free at point of care" whenever she mentions it. People don't really understand the cost via taxes or lack of service that comes with "free" healthcare.
In the lands of "free" healthcare such as Canada, the patient is pressured to accept euthanasia to reduce overall medical costs.
Medicine is never cheap and good medicine is even less so.
And then...
https://pmc.ncbi.nlm.nih.gov/articles/PMC1118378/
So that mother should bear the costs of each of those workers? Herself?! Maybe if there weren't a dozen or a hundred other patients involved on the same day, much less patients still being dealt with from previous days etc ... If healthcare costs weren't grossly inflated and subsidized by Medicare and Medicaid, and propped up by an incestuously involved insurance industry, ask divemedic if that hospital would still be able to make each individual patient pay every single even tangentially involved employee's salary. And further, why is divemedic pretending that that mother's presence in the NICU somehow changed the need for the hospital to pay those people? If that baby weren't there, would the NICU shut down? The nurses be out of furlough? No? That's called overhead. and while overhead does raise prices, in every other *same* industry on earth, they do not match prices with freaking overhead. Divemedic should next spell out why hundreds or thousands of dollars for a Tylenol is actually a perfectly understandable and reasonable thing. Or maybe explain how a house that cost my granddad $20k, should now cost $1.5 million. Or a house that I looked at ten years ago at $200k should now be $600k. I'm sure that's perfectly reasonable too.
Government run healthcare is a disaster. But healthcare with costs subsidized by the government and government -mandated insurance companies is just government run healthcare with extra steps and even more citizens getting bent over a table without lube.
Medicare/Medicaid accounts for 24% of the total budget of the USA.
That nuclear medicine stuff in pretty cool. Had it first about 45 years ago looking at heart function and again last year looking for cancer. We have to have the stuff flown in from out of town where they make it in a cyclotron. It had a 100 minute half life and was really juiced when it left Denver. They had a window where it wasn't too hot or too cold to work once it was flown here. It's a bit weird to see this heavy lined container being attached to your feed line. As I recall, those were $10k pictures.
I can easily remember the cost of a nickel (and its size) from back as far as 1950.
What is the size and cost of a nickel candy bar today?
I am delaying filing for social security for as long as possible - it would mostly go to taxes given my husband's salary as long as he continues to work full time, and I DO NOT want to file for Medicare. I avoid all doctors as much as possible, and want nothing to do with medgov and all the old whiny entitled people. I'm plenty old myself, but can think of a million things I'd rather do than go to the doctor for anything.
The hard thing is the regulatory cost. About half of what we pay has nothing to do with direct health care, but instead is to pay for "compliance," recordkeeping, and regulatory issues. This regulatory cost extends to every facet of healthcare, especially technology, where the requirements for validation studies and such are killers. The reason that CTs and MRIs are so expensive is that most of the cost of the devices is in regulatory burden. The remainder is in the hidden cost of making barriers of entry into the market so only those who have paid the price can pay.
This hit me twice in pathology. Many years ago, I worked with a guy who was developing an image-based method of doing blood cell counts. They had developed a machine that was *better* than humans. However, the FDA was using humans as their "gold standard" so they had to go back and try to change the machine to make the same mistakes that humans made. This was decades before AI, and it was just not worth the effort.
A decade later, I was involved in early efforts at digital microscopy. There was an explosion of new methods trying to do automated slide scanning. I worked with a guy who had developed a tiny scanner that would almost fit in your pocket and would cost about a thousand bucks (in 1995). Things were exploding. Then, around 2003, the FDA decided that these should be regulated. That added millions to the cost of development, and most of these early efforts died. Instead, only a couple of companies that had "paid there dues" had entry. The costs skyrocketed. There's a reason you can't buy a $1500 slide scanner. It's the government.
And every patient pays that hidden cost.
Got to go with DiveMedic here. Wife was transported to the ER after EMTs came to the house on my call. Long story short, she went into ICU and went back and forth between ICU and CCU for two weeks. 28 doctors worked on her; her problem was only discovered by accident when the head cardio doc happened to see an X-ray done by the head respiratory doc. Cardio doc told us she probably wouldn't survive the recommended procedures so she went into hospice and died a week later. So two weeks in he hospital and a week of hospice - the bill I saw was $380,000 - and that was 10 years ago. Care was top notch. (I was told her case would probably be written up in the NEJM.)
While I am not in medicine, I know my 'direct' engineering labor charge has a multiple of 2x or 3x for overhead. That may seem like a lot, but it includes having people available to answer technical questions that only a specialist would know, the building and facilities, and the inescapable management who I actually find useful.
0007, my deepest sympathies on your loss.
In areas of "Free" health care, the child would not have spent 30 days in NICU, there would not be NICU beds available and the child would probably have died.
Since your original injury was workman’s comp I would think that insurance would cover fusions above and below the original because of domino effect. I had a two level fusion in 2011 and workman’s comp would have covered doing the next level a few years ago but I declined doing it. I am on Medicare and I pay a hundred something out of Social Security plus about $400 out of pocket for coinsurance and prescription coverage! I have had several hospital stays plus three months in a nursing home to facilitate four times a day IV antibiotic treatment. No out of pocket but I did also pay premiums for forty years. The cost of medicine involves inflation plus government in cohorts with big pharma setting protocols that benefit the drug companies plus an aging population!
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