The Sick, She is Expensive
August 20th, 2008 by 
Madeleine Robins
My fondness for medical dramas, medical mysteries, medical documentaries, plague thrillers and the like doubtless has its genesis in shows like Doctor Kildare and Ben Casey (I liked Kildare better because Casey’s arms were too hairy. I was very young).
These days as a consumer of Modern Medicine(tm), I’m frequently awed by all the cool stuff they can do, the extraordinary leaps medical science has made in my lifetime. But I was reminded of another leap while reading a TV Guide that Sarcasm Girl brought me back from her vacation. It had Illya Kuryakin on the cover (I was young, okay?) and listings of television shows from 1965 that I barely remember (and others I remember embarrassingly well). There was also a bound-in ad for medical insurance. It notes in tones of alarm that the average cost of an overnight stay in the hospital had doubled in ten years. From $18.35 to $36.83.
So I got curious: what’s the average cost of an overnight stay nowadays? Granted, it’s forty years later, and nothing I know of has gotten less expensive. But I googled about, and the best estimate I could find was around $1000 a night. I assume that is not including tests, medication, surgical and medical services and soap in the shower: just the room with all its cool technology, and the nurses and orderlies and support staff.
I do understand the concept of overhead, of the hospital having to pay electricity and water bills and the salaries of everyone from the CEO to the janitor. To keep the paint fresh and make sure the rooms are dust-free and the linens changed. And I know that the new, cool technology comes with large price tags. But holy hats. 27 times the 1965 cost, just for a night in the hospital.
Jane Eyre had it right: “I must keep very well and not die.”
Posted in Daily Life | 
13 Comments »
August 21st, 2008 at 8:11 am
Heh.
Most working class folks in America have no idea that most industrial nations tend to regard American health care as a hideous Orwellian nightmare.
Every time I hear someone objecting to socialized medicine on the basis of personal choice or timely care I have to wonder if they’ve actually had to receive care under our current system.
The root of the problem is the profit motive. People are dying in order to maximize returns on investment — and the system is choked with parasitic money filters.
I ain’t arguing against capitalism in its place; health care is not that place.
I’ve got a doctor pal who’s having trouble getting medical coverage for a back condition that he acquired while working in the emergency room. That would pretty much be my final statement on the subject.
(Interestingly, I just got done writing a scene in my novel where my character goes into crippling debt due to an emergency room visit following his first big fight with a supernatural monster. Conan never had to put up with that kind of nonsense…)
August 21st, 2008 at 11:19 am
Analysts expect the health care system to cost 17% of American GDP in 2009. Now, suppose for a minute that we don’t institute universal health care and get control of costs. If costs increase at 10% per year, in seven years we will be spending 30% of our GDP on health care.
Even if costs increase only at 5 to 8% per year we are still headed quickly down the path toward an economy where health care is the nations largest industry.
Sounds like background for some good What If stories.
August 22nd, 2008 at 1:56 am
Highly recommend the Frontline episode that compares other health care systems in 5 other countries:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/
August 22nd, 2008 at 2:50 pm
I just got done writing a scene in my novel where my character goes into crippling debt due to an emergency room visit following his first big fight with a supernatural monster.
I love it when authors think through stuff like that.
August 22nd, 2008 at 6:47 pm
Here’s my medical what-if story — if anyone wants to use the notion, feel free — the nursing draft.
The baby boomers hit senescence only to find that there just aren’t enough nursing home staff to keep them healthy and happy — they respond by using their political clout to institute a nursing draft.
I kind of think it might actually happen…
(TomB! The kicker is that about a thousand bucks of that went to a CAT scan he was given because he had a head wound and claimed he didn’t remember everything that happened in order to avoid having to tell a complicated lie. Bwah-bwah-bwaaaaw.)
August 22nd, 2008 at 7:58 pm
Sean,
I can only think of the irony that my mother, toward the end of her nursing career, could only work in inferior nursing homes because she had health problems.
Lacking insurance to care for her health she couldn’t pass the physical to get a job in a hospital, which would have provided her with health insurance.
Rather than a nursing draft we now have illegal immigrants working the bottom layer of health care. They are the untrained nurses aides who do the real grunt work in the low end elder care facilities.
August 23rd, 2008 at 1:58 pm
As one who works with nurses I’d suggest you probably want people who really want to be nurses. If you draft them… Well, I’ll leave that to your imagination. (Vietnam & fragging come to my mind.)
As far as the reasons for the dearth of nurses in the US, it’s talked about as the ‘ER’ effect. The hugely popular TV show depicted nursing in less than glamorous terms. Coupled with affirmative action programs and raised expectations, women turned away from the traditional career path and signed up in droves for med school instead.
You may note across the entertainment spectrum, depictions of nurses & nursing range from repugnant (oow, body fluids!) to incompetent or sadistic/tyrannical (Nurse Ratchet) to inconsequential (‘House’). Granted, there are those that show great compassion and professionalism. But which to you remember most?
The median hourly rate for garden variety staff RNs in the US range between $21 to $30 (here it’s $24 to $35). Specialties run much higher. Depending on the staff model for a given area, that could be 1 RN per specified # beds, plus their supporting cast of LPNs & NAs (and a small army of admin types, such as clerks to manage patient records and staff to certify staff licensure & education). That slice of healthcare alone contributes greatly to the cost of a hospital stay.
August 23rd, 2008 at 6:04 pm
Stuart — My sympathies to your mother. It’s very distressing to hear about another instance in which a worthy person failed to receive the support that was their due.
LDA — Now I feel a little guilty — I recently sent out a story that featured a caregiver in a low-end nursing home in a very unflattering light. What can I say — the story needed an ugly crime and a caregiver gone wrong has a nasty tone to it. (I did try and portray the hospital staff in a flattering light in the novel, though.)
You’re right about the draft issue — Vietnam was on my mind when I came up with the notion (one man’s tragedy is another man’s plot…) — but when the need becomes desperate enough…
I’m curious. When you mention staffing costs, do you see any of those people as being superfluous or is that situation simply the cost of doing business?
To clarify, when I made my above-statement regarding ‘parasitic money filters’ I was thinking about the insurance industry and the associated lawyers, private investigators and so on, not the hospitals.
August 24th, 2008 at 10:30 pm
Sean – Plz don’t feel guilty; in good fiction there’s always an element of truth.
Superfluous? I’ve heard it mentioned that in the ‘good old days’ nurses did more with less. But it comes down to a number of factors. Growth of medical technology and interventional resources that can both shorten & lengthen hospital stays (which in turn require more nursing education and training), on-going development of nursing best practices, and–topping most everything else–patient safety. I’ll refrain from waxing philosophic on the societal expectations we have of our healthcare system and the underlying profit incentive (i.e., lawsuits & insurance) that drive these factors.
September 23rd, 2008 at 10:18 pm
Those numbers sound awfully low. I remember it cost about $350 a night, base rate, in the early 1980s.
October 23rd, 2008 at 10:15 pm
Interesting thread. A night in the hospital is well over 1000USD for any type of specialty care at all, and does not include xray- think 500 CT scan think 1000, MRI think 3000, and professional fees, subspecialists etc.are more. Neonatal ICU stays are often in the half million range similarly, end of life prolonged ICU stays on ventilators and what not. Nursing costs is usually bundled into hospital costs, as nurses are usually employed by hospitals, but doctor fees are usually not. As a medical person myself I am grateful that our jobs cannot be outsourced or offshored. That means that a nurse- often the head of household and parent, who makes 25-30/hour with benefits can actually support her family. That’s a good thing. Most nurses I have had the pleasure to work with are highly professional, hardworking and caring- sure there is a lot of burnout too, but decent working conditions, unions, liveable wage have all helped preserve nursing as a worthy profession.
Medical fiction is a great and underwritten scifi genre- and of course there need to be individual villains. But we absolutely do need to write the truth, expose the real evils- a society that simply cannot face death, disfigurement, or imperfection. The obese Frito consuming alcoholic who costs us millions in cardiac care and the health plan, cardiologist, pharmacist and “system” that is complicit.The 45 year old who cannot face the failure of childlessness and has IVF, then premature twins requiring a lifetime of special services. The system that puts a profoundly retarded child on a ventilator to prolong life because children don’t die in the 21st century. WE preserve life at all costs- both the monetary and the horrific toll of physical, emotional and spiritual suffering.
BTW national service AKA the draft is a great idea. Imagine wasting 30,000 dollars a year to send an unexperienced, immortal, idealistic 18 year old to college so they can drink and get laid. Make everyone build roads and care for the elderly for a few years until they have any idea at all what life really might be about.
Keep up the great What if stuff-
October 25th, 2008 at 12:47 pm
Gwench, I found your comment hung up in moderation — not sure why. I just set it loose. Glad you posted, and sorry for the lag in getting it up.
December 12th, 2008 at 1:35 am
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