Health Care Palaces and How They're Paid For

A few days ago, I was driving across the Northern Virginia suburbs with my wife.  We were on our way to Old Town Alexandria to attend a wedding, and as we puttered our way through the inevitable traffic, we passed the massive construction site that once was Landmark Mall.  Landmark wasn't ever the most successful of malls, even back in the 1990s, and like so many of those monuments to late 20th century consumerism, it couldn't withstand the onslaught of Amazon.  I bought a fridge at the Sears there once, and would pop in to the Avis there to rent SUVs when it snowed.   That was about it.  After the Sears closed in 2017, it just kinda sat there empty for a while.

It was a prime property, though, and is now being redeveloped into a massive hospital complex by INOVA, the nonprofit entity that dominates the Northern Virginia hospital and health services market.

Like most organizations in the health care sector, INOVA's pretty flush these days.  They've been expanding a whole bunch lately, at least in areas where there's still population density and wealth.  Back in 2020, they dropped a couple hundred million to purchase the former national headquarters of a little outfit called ExxonMobil, a massive office complex nestled in dozens of acres of wooded land right by the Beltway.  They made it even fancier, a great edifice filled with specialists and services.

They're growing, and I suppose in this era when the rural parts of our country have become a health care desert, I should be grateful for that.

But where does all the money for these sprawling new facilities come from?  Despite some major donors and philanthropic inputs, most of that money comes from us.

I'd noted...in a sermon earlier this year about poverty and what it means to be Christlike towards the poor...that the average ER visit now costs a tick over three grand.  

This isn't quite right, as I discovered after a recent five hour visit to an INOVA ER.  The billing from the ER that treated me included a three thousand dollar charge for receiving ER services, true.  But that's only for entering the facility.  There were other charges.

The bill for the ER doctor alone was $1,400.  I mean, he was helpful and all, no question, but that represents about a half hour of his time.  $2,800 an hour?  

The total bill...charges for imaging, for pharmaceuticals, for doctor services, for nursing services, and for miscellaneous fees and charges...ended up totaling over $11,000.  For five hours, no surgery, no invasive procedures, nothing but confirming a diagnosis and prescribing a different antibiotic than the one I was already on.  Eleven thousand.  Again, the care provided was fine, but the cost?

It's what you pay if the alternative is pain and death.

I'm blessed with insurance, so I only footed 10% of the eleven grand, but that total bill?  It ain't something most Americans have just lying around.  In fact, it exceeds the total savings of the median American by thousands of dollars.  That's "median," not "average," because wealth is so concentrated in the hands of the rich now that the "average" is essentially meaningless.  

If you're uninsured, that's "now you've got a problem with debt" money.  It's "put you on your back foot financially" kind of money.  It's why we're saddled with paying insane amounts for our insurance, and why insurance costs have risen to levels that are nothing short of punitive.

So as I drove by those rising health care towers in the ruins of an old mall, I found myself thinking about how they're made possible.