Hospitals build out capacity based on projections of need. So they look at the population of their catchment area, other hospitals, demographics of the locals, and calculate that they’ll need about X icu beds / maternity rooms etc etc and then build in a small overcapacity for surges.

If they routinely overbuilt then cost would go up even more. I think this approach is reasonable for any business,* whether private or public hospital.

The Covid surge isn’t something you can plan for, nor could you really build ICU capacity quickly enough for.

Also there’s a systems issue: the ICU pressure shouldn’t even exist to the degree it does as we have a “defense in depth”: vaccination. But for some reason people aren’t using that defense, which simply makes things worse for the rest of us.

* not getting into the cost issues in general, just addressing your specific comment.