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My daughter had a similar birth and hospital stay, which also produced a million dollar insurance bill. It costs about $10,000/day to stay in the NICU. I was ne

• fennecfoxen 13y ago
  If we think microeconomics for a moment: healthcare for distressed infants could be a textbook example of inelastic demand. Q: How much are you willing to pay to save the life of this child? A: ALL THE MONEY! AND MORE!!
  • thaumasiotes 13y ago
    People are a little more willing to spend someone else's money on less-than-worthwhile pursuits than they are to spend their own. As long as the customers aren't bearing the cost, everything they buy will have a similarly inelastic demand. Healthcare for distressed infants is certainly not an example of inelastic demand where people have to pay for it themselves; even food for healthy infants (a much smaller, and much more cost-effective, expense) doesn't show inelastic demand.
    • ForHackernews 13y ago
      > Healthcare for distressed infants is certainly not an example of inelastic demand where people have to pay for it themselves Are you kidding me? If it was a question of saving my child's life, I'd spend every last cent I had and then go sell a kidney.
      • thaumasiotes 13y ago
        I gave you an example. Mothers uncertain of their ability to raise an infant will abandon it to die (this is traditionally called "exposure"). It's a practice at least as old as humanity. And it conclusively demonstrates that the demand for infant care is not inelastic; these mothers aren't killing themselves trying to preserve their nonviable children. Rather, they're killing the children so that they don't die themselves in the effort to save a doomed child.
        • judk 13y ago
          "So that they don't die themselves" != "because they are unable to raise an infant"
          • thaumasiotes 13y ago
            If you take this view: > If it was a question of saving my child's life, I'd spend every last cent I had and then go sell a kidney. there is no distinction between being unable to raise a child, and being unable to survive the attempt. If you survive, the child will get raised. The only way to fail is by dying (or killing the child).
        • fennecfoxen 13y ago
          I think your example conclusively demonstrates that people in radically different economic and cultural circumstances have different attitudes towards their children. This is a completely fair conclusion, but has very little bearing when reasoning about health care for infants in modern neonatal ICUs, especially infants with rich technologist parents.
      • mgkimsal 13y ago
        At some point you'd run out of organs to sell, and the child still might die, sad as that may be. :/
      • shasta 13y ago
        I don't really understand how anyone can lump a real child with whom you have years of shared experiences, who you've loved and taught and who has a personality of its own in with a lump of cells that's yet to have a coherent thought.
        • DanBC 13y ago
          I'm assuming you'd be annoyed if you had a hand or foot amputated? And they're just lumps of cells that have never had a coherent thought.
          • shasta 13y ago
            Did you really think my argument was that anything that is a lump of cells that has never had a coherent thought has no value? I can understand a sense of loss in losing an infant at birth. You make plans for the child and are excited to meet the person they will become. It's a miscarriage. A similar loss is learning that your spouse can't get pregnant in the first place. It's not the same as losing a child of 3, 6, 12 or 24.
            • waps 13y ago
              Just correction a misconception here. The human brain "boots" on the 18th day after conception (you can set your watch to it). It is obvious on echo pictures that coherent thoughts are present on the 21st day after conception (e.g. if awake, most kids are aware that they're being pictured and attempt to find and play with the source of the sound, I think that qualifies as coherent thought). It is quite obvious on the 23rd day that fetuses are swimming around and exploring their environment purposefully. They are at least as alive and coherent at that time. The reason for this is that your DNA does not contain a plan for a human being. It contains a plan for a bilobite (an very old and presumed extinct form of life), and a way to transform a bilobite into a trilobite, a trilobite into something that resembles a fish, that fish into something very similar to a frog larva, and so on and so forth until you get a human. Other species have the same evolution in the womb/egg, except it diverges at some point. The fish has a working brain (and it is unknown whether the trilobite does, it grows active neurons), generally referred to as a neural tube. That brain is working during the whole gestation period.
    • coldtea 13y ago
      >Healthcare for distressed infants is certainly not an example of inelastic demand where people have to pay for it themselves I take it you don't have a child?
• thaumasiotes 13y ago
  > I do think our medical system needs some rethinking though. You probaby don't want to hear it, but if I were running a medical system I'd decree that gestating one-and-a-half-pound globs (from the article: "One doctor, visibly shaken, described [the fetus's skin] as 'gelatinous'") outside the womb is a waste of resources. To me, if miscarriages aren't the end of the world, neither are "babies" that die of natural causes within a few minutes of being delivered. There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis. The cost of replacing the thing is much, much lower.
  • paul 13y ago
    I'm aware of that kind of thinking, which is why I'm glad you aren't running the medical system. Consider who you're talking about when you say, "The cost of replacing the thing".
    • raintrees 13y ago
      If several dollars a day will keep people in certain parts of the world alive, doesn't the question become how many must die to save this one life? http://www.globalissues.org/article/26/poverty-facts-and-stats http://www.globalissues.org/article/26/poverty-facts-and-sta... I am hopeful that this is not a zero-sum game... And for the record, I think this is the wrong battle, health care is entirely too expensive in the first place.
      • rwissmann 13y ago
        No it doesn't - these are not mutually exclusive choice. How are expenses for US health care and aid to foreign countries related? You could just as well budget the money for the latter against the expense for a coffee, an aircraft carrier or Armstrong's salary. I totally agree that health care is too expensive at the moment.
    • shasta 13y ago
      I agree with your parent and thus don't want you in charge of "running the medical system," either. But we don't have to have one or the other. You buy your insurance policy that covers whatever it takes to save your fetus and I'll buy my policy that doesn't (and spend the difference on improving the lives of my healthy children).
• tarr11 13y ago
  It is unfortunate that Tim Armstrong made these statements and all of us who have had this experience need to relive it. My daughter also had an extraordinary birth, and was saved by the incredibly expert care of a dedicated team of medical professionals at multiple hospitals in Seattle and Bellevue. The bill I saw was north of 250K and I paid the max of that (which was a few thousand) It occurred while I was at a startup which i had co-founded (and currently employs over 100 people). I tend to go from startup to startup, with some contract / FTE work in between, and have swung from COBRA to COBRA to keep my health insurance consistent. Because of ACA, this is the first year that I didn't have to "get a real job" in order to keep pursuing startups.
• bilbo0s 13y ago
  "... except that this is a major profit center for hospitals, and they use the money to cover other, money losing, departments ..." I think you, like many people, misunderstand the reimbursement regime as it works in American hospitals currently. A patient in an ICU will typically have a DRG associated with him/her. This DRG relates to the acuity, and these in turn, impact the reimbursement level. This is because the complexity of care, as indicated by the acuity level, implies higher resource utilization. For instance, the patient-nurse ratio in a typical hospital room is somewhere right around 4:1. In ICUs this ratio is, more often, 1:1. The ICU also needs an array of techs for a patient... highly specialized techs capable of analyzing and acting on information coming off of the monitor that the tech is responsible for. So hospitals are not saying, "Hey... we have these people here who we can get a lot of money out of!" The system, as it currently stands, is "volume based", so money comes in for ICU care regardless of what the hospital wants. One of the issues with being volume based in this fashion, is that money does NOT come in for things like data analytics, nutrition departments and occupational therapy for instance. Now here's the rub... how do you offer comprehensive ICU care without due consideration of nutrition? Without the ability and expertise to analyze the data coming off of what could very well be an extensive array of monitoring equipment? It actually goes further than that... Most hospitals MUST have a clinical equipment department for which they are not reimbursed at all. Of course, the creation of an ICU withOUT a clinical equipment department is out of the question. So while there do exist cross subsidies in any given hospital, it misses the mark to view the departments on the receiving end of the subsidies as "money losing". This sort of thinking has led the industry to all of the issues we see presently. A good example is the poor reimbursement of primary care... and so primary care becomes "money losing" when viewed in that manner. Instead, I think these departments would better be viewed in the fashion that they are viewed in the "value based" reimbursement regime that the industry is currently transitioning to. Not only will care delivery facilities be in a better position to provide care to families like your own and others, but the quality of care will increase across that enterprise. Your family was given high quality care because the hospital took money from a "volume based" reimbursement system, and distributed those monies based on the judgement of what were probably some very clever "value based" administrators. I can pretty much guarantee you that they did not view Clinical Equipment, Data Analytics or Nutrition as "money losing" departments. One of the things that has been missing in the discussion about the health care system is the education of the typical citizen about the tradeoffs and compromises that, for example, hospitals are making internally to deliver the quality of care that they do. I think if the citizenry had a more full understanding of the nuances of things like the reimbursement system, we could have a more productive debate on the issue of healthcare.
• clavalle 13y ago
  My father in law is a neonatologist and was given an ownership stake of the NICU he started in a midwestern hospital. He makes around $4 mil/year. Granted, he does sometimes stay at the hospital for two weeks at a time with only very brief visits home but at this point he also owns apartment complexes, office buildings, a gentleman's ranch with a few dozen horses and staff and on and on. I think it is shameful, personally, that he profits so much. He works hard and he saves lives, it's true, but how much is enough?
  • selmnoo 13y ago
    Speaking as someone who is also familialy-related to a neonatologist and a cardiologist -- both of whom earn more than a few million per year, I'd say they deserve every last dollar of it. They had to go to school for some while, and work under very tiring schedules. Hell, their schedules are still to this day pretty sucky -- they often tell me how much they envy me for my startup I'll-do-whatever-I-want-whenever-I-want lifestyle. I think they both earn somewhere between 2 to 5 mil/year, but they spend it extravagantly and handsomely -- that's a very good thing. They're spending it on boats, cars, houses, nannies, restaurants, vacations, etc. etc. They're keeping the money going, they're spreading it out. They save lives, get money, and then help the economy by spending this money. Now, what IS shameful is what the salaries of these social-app CEOs are. Why is Zuck worth some 20 BILLION? He's just going to sit on it, unlike my uncles he's not going to spend the majority of it. Zuck isn't helping the economy, Uber isn't helping the economy (it's externalizing costs, privatizing profits -- if they didn't exist that'd be a good thing). What is shameful is the profiting from rent-seeking, from making a killing on capital gains, etc. etc. Getting a few million per year isn't that bad, because believe it or not, in the large scheme of things that's little money -- most importantly, it's money that one can realistically spend from year to year. Spending a billion -- that's a challenge.
    • clavalle 13y ago
      It's a good thing for them and the people selling them things but it is not so great for everyone else struggling to pay for decent insurance. I am sure those people would be happy to spend that money and keep it flowing as well.