Here are just a few things to add to the discussion. As somebody who has worked in different Emergency Departments for several years, I have a few responses to your thoughts. These are issues that repeatedly come up, and often I think patients are just simply unaware of how hospitals actually work.
You asked: Likewise, laser eye surgery started prohibitively expensive and now anyone who can save up $1,000 or so can get it. Why have heart operations not followed the same trajectory?
--There are several reasons that come to mind immediately as to why laser eye surgery remains much cheaper now than cardiac surgery. First off, the skill necessary to perform laser eye surgery is nowhere near the skill necessary for heart surgery. A cardiac surgeon goes through years and years of schooling and training, followed by a lengthy residency program, often several residencies. No cardiac surgery is truly ever truly "routine". You never just need a single cardiac surgeon in the room; you are paying for not just the skills of the cardiac surgeon, but also the registered nurses, scrub technicians, and anesthesiologists required to appropriately treat you during the procedure and post-procedure critical care. The drugs and IV fluids given during cardiac surgery are exponentially more risky to administer, and treating the complications is far more intricate and involved. Additionally, the equipment needed for heart surgery is much more complex and expensive than that for laser eye surgery. For both surgeries, this equipment needs to function perfectly every time around, and the vast majority is single-use only, for obvious reasons. In summary, in the ideal world, you are getting what you pay for: highly specialized critical care, expensive monitoring equipment, and the appropriate medications. Now, I agree, it would make the most sense to figure out a way to reduce costs, but the answer doesn't lie with the hospitals charging less for the same procedures. We need technical innovation in the medical field so that we can make major surgeries, like cardiac surgery, as minimally invasive and low-risk as possible. And while we are make progress, we are nowhere even remotely near the risk level of laser eye surgery. I believe the answer to this problem is going to come from better preventative care, which means that more individuals need to have access to a good primary care physician. The uninsured, and many with basic medical plans, cannot afford this. Of course there will always be those unfortunate individuals who even an amazing primary care provider cannot prevent the need for surgery, but disease prevention is the way to go here for the vast majority. And in order to do that, we need to focus on public health efforts.
--There are several reasons that come to mind immediately as to why laser eye surgery remains much cheaper now than cardiac surgery. First off, the skill necessary to perform laser eye surgery is nowhere near the skill necessary for heart surgery. A cardiac surgeon goes through years and years of schooling and training, followed by a lengthy residency program, often several residencies. No cardiac surgery is truly ever truly "routine". You never just need a single cardiac surgeon in the room; you are paying for not just the skills of the cardiac surgeon, but also the registered nurses, scrub technicians, and anesthesiologists required to appropriately treat you during the procedure and post-procedure critical care. The drugs and IV fluids given during cardiac surgery are exponentially more risky to administer, and treating the complications is far more intricate and involved. Additionally, the equipment needed for heart surgery is much more complex and expensive than that for laser eye surgery. For both surgeries, this equipment needs to function perfectly every time around, and the vast majority is single-use only, for obvious reasons. In summary, in the ideal world, you are getting what you pay for: highly specialized critical care, expensive monitoring equipment, and the appropriate medications. Now, I agree, it would make the most sense to figure out a way to reduce costs, but the answer doesn't lie with the hospitals charging less for the same procedures. We need technical innovation in the medical field so that we can make major surgeries, like cardiac surgery, as minimally invasive and low-risk as possible. And while we are make progress, we are nowhere even remotely near the risk level of laser eye surgery. I believe the answer to this problem is going to come from better preventative care, which means that more individuals need to have access to a good primary care physician. The uninsured, and many with basic medical plans, cannot afford this. Of course there will always be those unfortunate individuals who even an amazing primary care provider cannot prevent the need for surgery, but disease prevention is the way to go here for the vast majority. And in order to do that, we need to focus on public health efforts.
You asked: Why does an uncomfortable hospital room that's not even private cost $680 a night base rate? I still want to understand why hospitals are, at base, bad hotels, and yet they charge about 10x more than bad hotels in the same general area.)
--The answer to this is simple: It's because hospital are not hotels. They are not even bad hotels. In this country, we take for granted that when we enter the hospital, our medical concerns will be well addressed; that we will receive a correct diagnosis and be treated appropriately. A perfectly fair assumption, but what you have to remember is this: you are not paying for someone to fluff your pillow, leave you a mint with turndown service, etc. You are paying for the skill of your nurses to appropriately assess you, to be able to recognize even the slightest changes in your condition that might indicate you are getting worse (or better), or to know how to safely administer the drugs you need, for the skill of your floor technicians to know how to safely get out out of bed and to the bathroom, or how to cleanly insert your IV catheter, or turn and place you in bed without further injuring you, for the skill of your doctor to read your xrays, CT scans, bloodwork, etc, to make an appropriate diagnosis and plan of care based off said diagnosis. Hospitals cost so much not because of the customer service they offer, but because of the level of care they provide and the skill necessary to provide that care. Of course, there is something to be said about good customer service and hospitals treating their patients well. Hospitals should be invested in improving patient relations and satisfaction, because these patients will not only return to the hospital for the rest of their care, but they will also recommend it to their friends and loved ones. This is how the hospital can be assured to bring in more money, but it is not what your money is being spent on. Of course, as a patient, you should be treated with respect and dignity, but that is very different from expecting hotel-type service. And at the end of the day, the overworked techs, nurses, and doctors know that the most important thing is keeping their patients living and breathing. Most of the care and skill that is needed to keep patients goes completely unbeknownst to the actual patient. When your nurse walks into your room and talks to you, adjusts the IV fluids, adjusts your oxygen level, and repositions you in bed, she's doing more than just being nice. She's assessing you and noticing even slight changes in your level of consciousness, your cardiac perfusion, your heart rate changes on the monitor, making sure you don't get skin breakdown from laying in one position too long, etc. RNs, Techs, and Doctors are trained to do it effortlessly, and it often goes over the patients' heads. It may not sound like a lot, but if you've ever been a patient with a nurse/doc who misses the subtle cues of deterioration, you know how painful the results can be. You are in the hospital because you are not stable enough to be at home on your own, and at the end of the day, if you are getting better, the hospital is functioning correctly and as it should.
--The answer to this is simple: It's because hospital are not hotels. They are not even bad hotels. In this country, we take for granted that when we enter the hospital, our medical concerns will be well addressed; that we will receive a correct diagnosis and be treated appropriately. A perfectly fair assumption, but what you have to remember is this: you are not paying for someone to fluff your pillow, leave you a mint with turndown service, etc. You are paying for the skill of your nurses to appropriately assess you, to be able to recognize even the slightest changes in your condition that might indicate you are getting worse (or better), or to know how to safely administer the drugs you need, for the skill of your floor technicians to know how to safely get out out of bed and to the bathroom, or how to cleanly insert your IV catheter, or turn and place you in bed without further injuring you, for the skill of your doctor to read your xrays, CT scans, bloodwork, etc, to make an appropriate diagnosis and plan of care based off said diagnosis. Hospitals cost so much not because of the customer service they offer, but because of the level of care they provide and the skill necessary to provide that care. Of course, there is something to be said about good customer service and hospitals treating their patients well. Hospitals should be invested in improving patient relations and satisfaction, because these patients will not only return to the hospital for the rest of their care, but they will also recommend it to their friends and loved ones. This is how the hospital can be assured to bring in more money, but it is not what your money is being spent on. Of course, as a patient, you should be treated with respect and dignity, but that is very different from expecting hotel-type service. And at the end of the day, the overworked techs, nurses, and doctors know that the most important thing is keeping their patients living and breathing. Most of the care and skill that is needed to keep patients goes completely unbeknownst to the actual patient. When your nurse walks into your room and talks to you, adjusts the IV fluids, adjusts your oxygen level, and repositions you in bed, she's doing more than just being nice. She's assessing you and noticing even slight changes in your level of consciousness, your cardiac perfusion, your heart rate changes on the monitor, making sure you don't get skin breakdown from laying in one position too long, etc. RNs, Techs, and Doctors are trained to do it effortlessly, and it often goes over the patients' heads. It may not sound like a lot, but if you've ever been a patient with a nurse/doc who misses the subtle cues of deterioration, you know how painful the results can be. You are in the hospital because you are not stable enough to be at home on your own, and at the end of the day, if you are getting better, the hospital is functioning correctly and as it should.
All that being said, healthcare is prohibitively expensive. This is especially true for those with no health insurance, but the bills can quickly add up even for those with a fairly high-end insurance plan. While I am certain there is much hospitals could do to cut costs, the answer doesn't lie entirely with the hospitals. Insurance companies operate at outrageous profit margins while denying coverage of even some of the most basic and necessary care. I see it every day at work. Private insurers have unchecked in our system for way too long. They are the only option, and they are robbing people of not just their money, but also their health and in many cases, their lives.
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