Comment by duffpkg | Hacker News Reader

Comment by duffpkg | Hacker News Reader

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An ICU unit isn't exactly a single room. There are different configurations but they typically involve some sort of centralized monitoring station and 5-20 ICU "beds". Total cost of that / number of beds. Everything in hospital construction is expensive, ICUs are at the extreme end of that. Huge power requirements, medical gas lines, fixturing and surfaces needs to be able to be disinfected, special air, special water, on and on. It has requirements very similar to an operating theatre.

The reason they cost so much even if no one is in them is because of what a "bed" means. It isn't the literal bed, it is a unit a treatable/treating capacity. Requiements vary somewhat by jurisdiction but it's going to mean 24/7/365 nursing and attending doctor staff. You can't just call them in when a patient shows up, they need to be scheduled and available. Then ICUs will also need a large cadre of oncall specialists, neurologists, cardiac, laboratory testing staff, and on an on to cover a huge range of possible patient needs. Stocked blood units, stocked medicine units. All those things have costs whether a patient in in the bed or not. Hospitals to a large extent spend an incredible amount of money on capacity. No wants wants to end up in a hospital to have them say, "oops, we didn't expect your spleen to rupture today, Dr. Bob won't be in till next tuesday so you are out of luck, sorry"

To add to this, the costs the one area I understand are huge.

Radiology generally needs to have a CT ready to go when there is an ICU. It likely needs an MR too, and staff for running after hours. Portable X-ray and ultrasound, a PACS, a RIS, services contracts and a load of other smaller costs.

That’s several million in hardware costs.

The running cost is huge with MR service contracts alone into the hundreds of thousands per year.

Staffing utterly dwarfs that expense and getting skilled people to work out of hours requires a lot of money, and additional cover for when they sleep.

Staff need to be kept competent with courses and training, certificates and leave to get to these sessions. More money.

The consumables are silly expensive and expire fairly rapidly. Everything needs to be available and a few spares should be present.

Radiology can be a cash cow for day to day operations in a private clinic. But having staffing and equipment that can run 24 hours a day with 100% uptime is a massive cost multiplier.

So, they're complicated, they're expensive, they're necessary... why don't we have the state pay for them? We spend 720 Billion dollars on the military. Would it be useful to send a couple of those billion to make ICUs less expensive?

Yes it would, but in the US we have a for profit medical system so this is a natural result of that.

Where do you think state money comes from? Even if it’s the government that foots the bill for ICUs, in the end it will still be paid collectively by all of us regular people.

Well good thing regular people don't ever need to use ICUs.

Did you reply to the wrong comment?

No.

In case it was unclear, I was being sarcastic in my reply and pointing out the hypocrisy of being offended that "regular people" would have to foot the bill for ICUs - as if they weren't the ones relying on their existence.

I am not offended that regular people would foot the bill for ICUs if state decides to pay for those. My point is that I do not see why it would be an improvement in any way over the status quo. It will not make them cheaper or more available, most likely quite the opposite.

Where do you think the for-profit money goes? (HINT: it’s in the name.)

Most hospitals in the US actually are non-profits, but that’s really beside the point. Just because something is for profit or non profit does not allow you to immediately conclude anything about its cost. For example, the government in my city built a 3 stall public restroom at a cost of $638,000. At this price, if I wanted to have a restroom built on my behalf, I’d rather hire a for-profit contractor to do it instead of the putatively non profit state.

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