I would really like to see a breakdown of the actual costs to provide a given service. Take something simple like removing an appendix or gall bladder. You have one surgeon, one or two surgical assistants (typically med students / interns), plus a couple nursing staff, and the anesthesiologist, for about an hour. 6 people, assume 200K per year, that's $100 per hour, so $600 in people salaries. (Throw in another couple hours total for prep time, consultation, planning, etc, still you are talking less than 2k).
Then you have amortization of the equipment and operating room, and some fraction of the hospital support staff during the prep and recovery stages. But even with that I still don't see where the $80,000 for the surgery cost comes from.
They are the person most able to kill you when they screw up, so a significant portion of that bill is insurance. They also make $300-500k.
Also recovery room or ICU time is very expensive -- something like $1000/hr in some cases.
That type of procedure (gall bladder) will cost something like $15-20k.
When I had a spinal fusion, it was a 4-5 hour procedure involving a neurosurgeon, his PA, an anesthesiologist and his nurse, and 4-5 others. That procedure cost ~ $125k.
Aren't healthcare list prices in the US really really distorted and nonsensical, due to decades of messed up incentives between hospitals and insurers?
Cannot speak for the cause, but the prices are distorted. I was taken to ER a couple of months ago and x-ray of chest cost $3500 and CT of chest $5500. The equivalent prices at the private sector of my home country would have been $70 and $120 and I could have gotten those done just as quickly as in ER in US.
I've actually found that you can get list prices from hospitals. The problem is that they're distorted and sky-high and not necessarily very reflective of what you will have to pay if you have insurance, because the insurers have negotiated their own rates. Those rates are treated as top secret by everyone involved (that is, until you get a bill).
It's because in healthcare, the vendor never knows if or when they will be paid, and how much it will cost to get paid, so the strategy is to charge as much as possible and just hope for the best. That means people who are dead broke get their care for free since they have nothing to pay with, insurance companies and the government strong arm the vendor into discounts since they buy in volume, and the person that gets screwed is the little guy who makes enough money to not be poor, but not enough money to have gold plated insurance but he also can't fight the hospital.
Then you have amortization of the equipment and operating room, and some fraction of the hospital support staff during the prep and recovery stages. But even with that I still don't see where the $80,000 for the surgery cost comes from.