Main reason I ask is because Chillindude, a prominent member of the competitive Melee community had a stroke recently and as he’s relatively healthy and works out often, he doesn’t have health insurance, and even though he’s sponsored by Team Liquid, one of the largest e-sports teams out there, because he is classified as an independent contractor, he doesn’t have health insurance through them.
The way he got the stroke was through an infection in his knee that he got misdiagnosed twice, and the hospital was going to throw him out even because he’s been stabilized, but doesn’t have coverage, which to me is actual BS but I’m honestly curious as to why this would be the case, considering strokes need so much recovery done for them.
Situations like this is part of why I couldn’t write my own thing for the ideal society post I made the other day, because I have no clue how healthcare should be handled. I do know however that portions of why healthcare is so expensive is due to the companies that make the equipment being anti-“Right to Repair” and the actual repair costs of the equipment being outrageous (Louis Rossmann made that a video months ago and I can’t find it), but still, this whole situation is really outrageous to me, that the hospital was going to throw him out after he stabilized due to a lack of proper coverage, and that stroke recovery as a whole is as expensive as it is in the US. I’d love to hear from our European people if it’s really any better there or am I being lied to, but still, idk what the solution really is.
Edit: I’m in the US, so this is pretty important for me to know.
I used to do product engineering for medical devices.
One of the reasons equipment is so expensive is that the costs associated with getting the approvals to be able to market/sell equipment. The US Food and Drug Administration has the longest and most difficult approval process for drugs and medical devices in the world, and it's not even close (though the EU is in the process of rolling out some new regulations that may give the US a run for its money). Then beyond the millions you spend on the clinical study, you must have an expensive business infrastructure to meet all the other regulatory requirements related to product design/development, defect tracking, etc... These things are all expensive, and the businesses pass the costs onto the customer.
The other part of it is that, as we all recently saw with the vaccines, the manufacturers try very hard to make it so the "customer" isn't the end user or even the hospital but rather the health insurance companies or the government. So they all try very hard to get a separate billing code, then lobby for that billing code to get reimbursed by the insurer or government. They know that the patient won't care about costs because they're just paying the co-pay, the hospital won't care about costs because they're billing the insurance, and the insurance might care but by the time they get the bill there's nothing they can do about it. So because there's no real cost pressure, the manufacturers know they can charge pretty much whatever they want.
As for "right to repair", that tends to go out the window for medical equipment due to liability. Hospitals generally don't like doing too much maintenance on complex equipment because the liability if it fails might shift onto them. If the manufacturer performs the maintenance using the approved procedures and approved replacement parts, the manufacturer stays liable. And even if a third-party performs the maintenance they will still have to use the manufacturer approved procedures and replacement parts and likely be trained/approved by the manufacturer. Using unapproved parts is a big no-no even if you think they're the same thing.
As for manufacturer markup, some of that is because they can, some of it is that they aren't in the business of selling parts so they may not have very many of them on hand, some of it might be the parts are old/obsolete and may be difficult to source, some of that may be the device manufacturer has specific requirements for the part manufacturers (eg specific part revisions, special firmware versions, etc...), and the part manufacturers pass the costs of meeting those requirements back onto the device manufacturer.
Beyond that, one of the things the FDA requires is that the manufacturer ensure that the end user use the product in the approved manner and make it difficult to use in an unapproved manner. So medical devices generally speaking aren't designed to be modified and in many cases are specifically designed to not be modified. This is why if you ever see a product that has a clinical and non-clinical version, the clinical version is usually a stripped down version of the non-clinical. And manufacturers will often make it so end users aren't able to run software from the non-clinical versions on the clinical hardware.
This is not to say it's all the government's fault: there are plenty of MBA shitheads at these companies who seem to go out of their way to extract as much blood from the boulder that is our healthcare system. But the incentive structure is set up for medical equipment to be expensive, so it tends to be.
I could tell so many stories for each of these items, but then this would become a book; so I won't.
I still appreciate the perspective. Thanks for sharing!