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.
The argument that other countries offer free healthcare is false. The care isn’t free, it is paid for through taxes. Even then, there aren’t enough professionals to go around, so care is rationed, and even Canada offers to kill the patient, putting them down like a race horse with a broken leg once the cost of their care gets too expensive.
There are ways to make this sort of care cheaper, but every one of those ways involves compromising the level of care. You can increase the nurse to patient ratio, but this means that the patient is left to fend for themselves for longer periods of time. You can get away with that for an adult admitted with a broken hip, but not for an infant that is near death.
Americans demand perfect healthcare, but then complain when the bill comes due. You want good care, and you want it now? Then it won’t be cheap.
32 Comments
Boneman · January 13, 2025 at 5:59 am
Exactly. I think folks just don’t realize the underlying true costs. Add to all you have listed the cost of insuring all of those folks working in the facility. It does boggle the mind.
What also boggles the mind is that people believe in the concept of “free” anything. NOTHING… absolutely NOTHING is free. Even the air you breathe. That’s right… you require ENERGY to inhale… that energy is not without cost.
Mike C · January 13, 2025 at 6:13 am
I’ll start out by saying have no inside experience in this. My forays into hospital cost and usage consist only of a couple of outpatient surgeries which were paid for by my insurance and my large (but modest by comparison to actual cost) deductible.
That being said, there is a deeper issue about rationed care. I know a young lady who, after getting pregnant by selling her body to support her drug habit, had her predictably premature baby who spent the next 4 months in neonatal care. After the baby was discharged, since the woman was back on drugs, it was placed in foster care for eventual adoption. I can only guess that the cost for care for this sad result was similar to the one that you noted.
Contrast that to my two coworkers who’s wives recently had perfectly normal and unremarkable births. I am assuming since both had brief stays in the hospitals that the overall cost was non-trivial. The difference was that the cost of their care was covered by their deductible and their insurance (and the company’s generous insurance premiums).
The question is, when giving money away, which is what is happening when you care for the indigent and poor, what limits do you set? Is it wise to spend a million dollars for the survival of one child, albeit one who’s parents made some very unfortunate life decisions? Its not sustainable to say there are no limits, everyone gets equal care. I believe you have made this point repeatedly. I also have no solution to this.
There is an evolutionary solution might be happening. Perhaps hospitals are increasingly going private and closing their doors to anyone who is not “covered” by their mega-insurance or private funding (the Kaiser model). Those hospitals that remain “pubic”, do so at their peril and end up with less resources and less skilled (lower paid) staff. While their customers get the best care they can give, it becomes increasingly less skilled and capable.
Divemedic · January 13, 2025 at 8:14 am
Going private would be workable, if it were not for EMTALA. The US used to use this model: You had private hospitals that required insurance or cash for providing care, then you had the ‘charity’ hospitals that were run by non-profits like churches.
Thanks to EMTALA, every emergency room has to take everyone, regardless of the ability to pay, which has of course caused prices to skyrocket.
Michael · January 13, 2025 at 7:56 am
Divemedic my daily read. You always tilt at the windmills of mediocracy.
The right side of the IQ bell curve can be reasoned with. Most of the time.
The left has offended FEEEEELINGS…
“Oh, “Tanstaafl.” Means “There ain’t no such thing as a free lunch.” And isn’t,’ I added, pointing to a FREE LUNCH sign across room, ‘or these drinks would cost half as much. Was reminding her that anything free costs twice as much in long run or turns out worthless.”
― Robert A. Heinlein, The Moon Is a Harsh Mistress
But then again on various “Patriot Sites” I keep seeing calls to “Punish the Doctors, Nurses, Pharmacists, EMS and such that pushed the VAXX”.
When reminded who’s going to respond when you call 911 they mutter darkly.
So even a reasonable IQ doesn’t surpass their opinions, Nor does facts like yours friend.
Divemedic · January 13, 2025 at 8:17 am
More on that in a later post.
pchappel · January 13, 2025 at 8:18 am
“Cheap, Fast, Legal… Choose 2″… Not talking about medical care at all, just seems to be a general statement from a Sci-Fi game. But it does seem to apply to a LOT of things…
Ed · January 13, 2025 at 7:44 pm
At work, we used cheap, fast, and Good, pick two
Tom235 · January 13, 2025 at 8:43 am
The difference between a “producer” nation and a “consumer” nation. IIRC, we made the transition sometime in the 80s.
Gandalf · January 13, 2025 at 8:45 am
Not really but there is coverage. Suffered another stroke right before Christmas and the hospital made sure I left with plenty of meds.
Filled out the anonymous hospital stay survey, even put down the food was delicious.
Medical professionals are worth their weight in gold, I wouldn’t be here without them.
Not their fault that big dumb incompetent gov is under the tent with stinky snout.
Barefoot Peckerwood · January 13, 2025 at 9:20 am
There’s a reason everyone wants medical care in America.
One of my daughters spent 100days in NICU after being born at 26weeks. In 1999 that bill was north $1.3m. I started paying what I could. Because I knew she had the best care available and was grateful for it. The State decided she was “disabled” and picked up most of the bill,. It I kept my end up.
JimmyPx · January 13, 2025 at 10:08 am
People bitch about the cost until they or a loved one NEEDS care then “cost be damned”.
For example people ask all of the time about marrow transplants for cancer patients.
It is very expensive and the odds are low for it helping you yet people want it because “only the best for me, damn the cost” … until they get the bill
I guarantee that the lady in your example would have demanded the best care for her baby no matter the cost. Then LATER after the baby was saved and doing OK do they bitch about the cost.
People don’t get nor want to get that those hospital buildings, equipment and staff all need to be paid for. The debate is by WHOM but it costs a lot of money to do so. There is no FREE healthcare just either the government via taxes or a combo of you, your employer and fellow people paying into an insurance fund.
Wilson · January 13, 2025 at 10:33 am
Our local hospital charges the going rate for health care , but gives a less than average care.
Divemedic · January 13, 2025 at 12:52 pm
As defined by?
Wilson · January 14, 2025 at 8:36 am
The medical over seers that look at the quality of care. I believe medicare is one of them. The hospital system here was graded poor .
Divemedic · January 14, 2025 at 9:08 am
By whom, and using what criteria? That’s the important question
it's just Boris · January 13, 2025 at 11:08 am
Perhaps when we’re in a post-consumer society, and Niven’s autodocs become a reality, healthcare will be “free,” along with food, basic housing, transport, etc. But even then, where do the raw materials and energy come from?
And of course we need to survive to get to such a post-consumer society… But that’s a different discussion.
BOTAN · January 13, 2025 at 1:14 pm
Nothing is free, there is always a cost.
Had a friend that married a Russian woman.
She has both passports and is a “citizen” in both countries.
She needed some dental work that would cost thousands in the USA.
So they went to Mother Russia and got the treatment for a few hundred US $ *hard currency”.
They didn’t use the Russian medical system they went to the “private” Russian system which only accepts “hard currencies”.
Divemedic · January 13, 2025 at 1:21 pm
That can be hit or miss. You pay people cash for medical care, you might wind up getting scammed.
Grumpy51 · January 13, 2025 at 3:07 pm
Then those of us on this side of the Rio Grande get stuck trying to deal with the “work” of someone barely qualified to use a stethescope, much less a scalpel. And patients and their families get all pissy with us because of “bad outcome.” Ma’am? There ain’t no fixing this mess….. (and then listen to getting berated and threatened with lawsuit)
Divemedic · January 13, 2025 at 4:32 pm
Exactly. I had a patient recently who was in the ED because of complications from her “silicone injection surgery” that was done in South America.
Skyler the Weird · January 13, 2025 at 2:24 pm
In the case of premies, socialized medicine will tell the parents we’ve done all we can then count the infant death as an abortion.
Divemedic · January 13, 2025 at 4:31 pm
That is how the NHS in the UK does it. Any death that happens within 30 days of birth is counted as a stillbirth and doesn’t affect infant mortality rates. I blogged on that 5 years ago
JimmyPx · January 13, 2025 at 5:03 pm
I so wish that those calling for socialized medicine REALLY understood the rationing involved.
For example, in those countries if you are 80+ years old good luck getting surgeries.
If your kid is born all screwed up, they will NOT get the care and treatment they do in the USA.
People bitch about the healthcare in our country but why then do so many people come here from other countries for treatment ? (and most of them from countries with socialized medicine)
Don W Curton · January 13, 2025 at 5:00 pm
While in no way complaining about the right people getting paid what they’re worth, I will complain mightily about the billing system and the insurance scam. I get a bill, there’s 15 different line items, most of which I don’t understand, and prices by each line. Let’s say the total is $10,000 as per the original hospital charge. The insurance company then takes that bill, changes every single amount on there (whether they pay it or not), and reduce the total to $5000. The hospital simply agrees to cut the bill in half. The insurance then pays their share, maybe $3000. Would make sense that I still owe $2000, but then I get a final bill that might range from $75 to $7500, depending. And none of the values line up with the original bill, none of the totals match, and now I got another 5 or 6 line items in the bill from “consulting” that were not on the original bill.
So how much of that original $10,000 was legit? How much was fluff to help cover the cost of others with no insurance? I’ve caught blatant “tagging along” charges where doctors were added later to the bill with claims they consulted when they didn’t.
If the original hospital would simply give the total due, with no fluff, no trying to cover other expense, but here are the services provided and the agreed upon values, it would cut a lot of aggravation out of the process. But apparently no one in the process wants the final customer to actually know the true cost. That leaves a strong scent of bullshit to the entire healthcare cost system.
Divemedic · January 13, 2025 at 6:27 pm
That is largely because Medicare is involved in the process.
Don Curton · January 15, 2025 at 10:21 am
So Medicare causes the hospital to overcharge by up to 100% (double the bill) just so they can haggle it down later with the insurance company? In which case your example of the lady complaining about a $738,000 bill means it should really be maybe a $350,000 bill instead. Or who the hell knows?
Again, I think the trained and qualified people should be paid appropriately, but in all cases I am highly suspect when the biller arbitrarily doubles and halves the bill with no real explanation.
Divemedic · January 15, 2025 at 1:05 pm
It isn’t that easy. Medicare rules are twisted, convoluted, and confusing. They have a list of prices that can be charged to patients with Medicare/Medicaid, another list that can be charged to patients with insurance, and third list for self pay. Woe be the hospital that deviates from that list.
Medicare doesn’t just dictate what they will pay, they dictate what everyone else will pay.
Healthcare professionals who play fast and loose with that can find themselves on the Medicare naughty list and will get their medical license yanked nationwide.
oldvet50 · January 13, 2025 at 5:11 pm
We have free healthcare in this country – for certain people. If you pay nothing and get healthcare, by definition, it is free (to you). Of course the rest of us pick up that cost, so we pay for something we don’t get. That system cannot go on much longer.
Randy Sanders · January 14, 2025 at 10:08 am
The cause of sky high costs can be summed up with three words. Lawyers, insurance companies.
Soapweed · January 14, 2025 at 11:48 am
Thanks for your perspectives on various topics.
I value your thoughts and appreciate you taking the effort and time to elucidate.
WallPhone · January 15, 2025 at 1:36 pm
Medical costs are unfortunately built on the voodoo of medical billing.
You can’t read a medical bill as a representation of reality like a power bill or water bill. They’re getting better in some aspects (computer health records do more closely match the eventual billing record), and worse in others, like DM’s note about EMTALA above.
I’m not very optimistic about AI, but more truly non-selfishly, grifting and much more evidence-motivated decision making cogs in the machine might cause significant improvement.
TakeAHardLook · January 18, 2025 at 9:51 am
Excellent and needed explanation!
I exited OB partly due to the fact that Obstetrics in America can be defined as “Two imperfect humans demanding a perfect human 100% of the time.”
Even God Him (Her) self doesn’t deliver on those expectations.
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