Explaining health care costs

[Hubbs]

So we've had a lot of threads about ways to reduce health care expenses, and I think some of them have provided great information about particular issues that people of all political persuasions agree need fixing. But what I don't remember is ever seeing a good breakdown of where some of the enormous costs for the simplest treatment come from, and I'm hoping some of our resident health professionals (or just resident knowledgeable people) will be able to help out.

A little over a week ago, a good family friend had a stroke. He's been in a nearby hospital since then, and someone in my family has gone to see him nearly every day. We've also talked to several of his friends and family members. He's still unable to speak, but regained pretty much all other functions within the first couple of days. Without getting too specific, I'll just say that he's run into some problems with his insurance. And this is where I get lost, because each additional day is costing him $5,000.

Now, I'm pretty familiar with this hospital, because I used to volunteer there. Volunteers handle most of the simple functions of the hospital - bringing food to patients, wheeling them from place to place, delivering medicine or equipment where it's needed, etc. My friend is in a section of the hospital with eight single rooms, and four nurses assigned to those rooms. Let's assume that it's four nurses 24 hours a day, and that they're paid $50 an hour. That's $600 a day per patient for that section. Obviously there are other non-doctor personnel who need to be available for the entire hospital if necessary, and my friend's section would be paying for a small percentage of that, as well as a small percentage of the basics, like laundry/bedding staff, cooks, utility bills, etc. They're also helping my friend get up and walk for about an hour a day - I don't believe it's even being done as any sort of official physical therapy program yet. (They want to move him to a different hospital, and the one time we visited while he was doing that it was a nurse holding his arm as he walked.) Let's say that the "basics" plus the constant nursing presence is an even $1000 a day.

My initial reaction to all of this was probably pretty typical - a stroke is a big ****ing deal, so of course the treatment would be very specific and expensive. But after learning some details, I can't figure out where the cost is coming from. I'm sure the first 24 hours were expensive - lots of emergency care, multiple brain scans with neurologists on call in case my friend needed drastic action, etc. Since then, however, it's been pretty straightforward. The hospital determined relatively quickly that he hadn't suffered any permanent damage from the stroke, and that the only recipe for full recovery would be the time he'd need to put in to learn to talk and gain full control of his muscles again. He's on your basic IV saline solution and he has a heart monitor. He gets one brain scan a day, and I'm sure he's paying his share of his neurologist's salary. I also know that hospitals pay for expensive equipment by divvying up the purchasing costs amongst the patients that use that equipment, so he's gonna be paying a tiny chunk of whatever the CAT scan machine is called. And he's getting a medicine with a name that I have no hope of spelling (or even pronouncing) correctly. When he's not getting his brain scan or walking around, he's in his bed watching TV or sleeping. So that's a portion of whatever his doctor's daily pay would be, a portion of a CAT scan machine that's probably used thousands of times per year, the minor costs are associated with things like his heart monitor and saline drip, his medicine, and whatever his tiny percentage of the hospital's malpractice insurance bill is. I realize that he's probably paying more for that malpractice insurance than someone with a broken bone or swine flu, because his condition is more serious. And I realize that both medicine and 30 minutes of a doctor's time can be expensive. But $4000 a day expensive? If that costs $4000 a day, my friend's neurologist should be a billionaire, and the company that makes his medicine should have a larger GDP than most Third World countries. Where the hell does it come from?

(To provide a quick secondary story so the focus isn't specifically on stroke treatment, I went to the hospital about a year and a half ago because I had a strange feeling of pressure in my chest. My family has a history of heart issues, so I was worried. I talked to one nurse who led me through the paperwork and took my vitals, sat on a bed for half an hour, then described what I was feeling to a doctor who X-Rayed my chest and gave me an EKG over the course of another half hour or so. If you haven't gotten an EKG, it's one of the simplest processes of all time. So there was that, the X-Ray, and half an hour with the doctor, who wound up telling me that I had the incredibly dangerous condition of... drumroll please... heartburn. Apparently heartburn sometimes occurs without pain. My esophagus was swollen and pushing outward, causing the pressure. I picked up some Pepcid AC on my way home. Total bill? Nearly $800. Naturally, my question is... for what?)

[Thiebear]

I'm not a doctor and don't play one on T.V.

Rooms costing 5K is no different than Tylenol costing 83$ or a sani-wipe 12$

(markups from those that haven't paid)

It's something i'll never understand. Its seems to be a self fulfilling prophesy.

Eventually Nobody can pay.