So one of the things that comes up a lot is that it's not actually that correlated with cost.

Most vets I know (I also work for a state school, not a for profit company) are very sympathetic toward very large and expensive bills, and have always been up front about cost in a way that human medicine is not. There's also a myriad of ways they try to reduce bills when they can.

The toll is from folks who aren't spending much smaller amounts of money on life saving procedures.

The absolute amount of money is irrelevant, it matters what percentage of a person's disposable income it is.

$10k is nothing if you making half a million dollars a year and have $200k in credit with no balance, because your disposable income is probably $400-450k/yr.

$200 is a ruinous amount of money if you make minimum wage and take the bus to work because your disposable income is very likely negative.

Yeah, well if someone can't swing $200 they probably shouldn't own a pet.

one's financial situation may change very rapidly, and humans have an innate need for companionship and comfort.

> Yeah, well if someone can't swing $200 they probably shouldn't own a pet.

I'm not sure poor people not adopting pets would meaningfully change the rate at which pets are born. It just results in fewer pets being adopted.

Particularly true if shelters fix pets before putting them up for adoption.

Most animals that have been bred as pets over 1000s of years are no longer permitted to live without a human caretaker.

If they can't swing $200 for a life-saving procedure for a pet, I'd still advise them to adopt a pet to provide it a home for the window of time when the animal could happily live without any vet services.

A no-cost (or low-cost) adoption is often a life-saving procedure for an owner-less pet.

What gives you the impression these are adoptions?

Just an availability heuristic.

I grew up poor, by US standards at least, and everyone around me either adopted their pets from shelters or found them as strays on the street. All my pets have been either strays or from a shelter.

The only exception I can think of from my childhood were fish, I think those almost always came from a pet store, but fish tanks were very uncommon.

Even my Axolotl was a rescue, it was given to me in a Tupperware container full of pond water after its previous owner was unable to take care of it.

If you have anything that would suggest it’s common for people who can’t afford $200 in vet services to buy their pets from breeders, I’m open to learning.

That's an extremely easy thing to say from a place of privilege, and of course there is some truth to it. On the other hand, how many chronically broke and miserable people out there are only hanging on for love of a pet (perhaps the only consistent source of love and meaning in their adult or entire lives)? I'll bet its a lot. But fuck them, they're poor so I guess they should either tough it out alone or die.

Sorry to be so harsh about it, but your comment lacks basic empathy so I figured I'd give you a little dose of same.

Back when I was broke I owned a cat. There were literally times in my life that the only reason that I didn't paint the ceiling with my brains was because I was worried what would happen to that cat.

I'd love to have a pet too, but I don't have the conditions for that (including financial conditions), so I don't. Even though I'd love to. But having a pet is responsibility, which includes financial responsibility. So yes, you shouldn't have a right to have a pet, when you can't afford it. That it may even be controversial is bewildering to me. Animals aren't things which exist for your pleasure.

Pets are companions who you steward because you're the name on the lease and the one with the bank account. Like all living things, they're usually healthy without intervention as long as their basic needs are met. If you can fulfill that stewardship 100% of the time for 5 or 10 or 20 years, but then can't pull things together in some exceptional case at the end, that's not a failing. That's just one of those sad things that happens in life.

As long as you can afford basic care for a pet, then you can have a pet.

food, water, bedding, the ability to keep it safe, vaccines(they're pretty cheap mostly and often done by animal shelters for free--neutering too).

There are so many pets in shelters who could live good happy lives but no one is there to adopt them.

Better a pet to live with an owner who cant afford their chemo when theyre 14 years old than to be euthanized at 2 years old.

Who are you proposing should carry the cost then? Society?

Well decades before people didn't graduate with hundreds of thousands in debt. If you follow that chain and look at the colleges which have been replacing highly paid professors with adjunct professors paid little more per hour than people who make french fries its not professors sucking up those costs. It looks more like trying hard to minimize money paid to professors while charging what the market will bear wherein the price the market will bear is inherently distorted by huge piles of government money available that people are in turned obliged to borrow in order to break into their desired profession.

As with everything else we are currently screwing up we could do well to look at what smarter countries are doing.

Smarter countries are providing pet care for people who can't afford it? Which country do you mean exactly?

Smarter countries make education affordable instead of a government sponsored bonanza for the financial class leading to greater supply of vets who haven't had to front load their life with 200-400k in debt to reach the starting line of their profession. This leads to more supply per capita in theory and in fact.

Having enough supply means that when fuzzball junior has a health problem you don't have to choose between going into hock for $500-$1000 for an emergency vet, paying rent, or waiting a month for your regular vet who is also obliged to bill at a level that will pay costs, and repay their lender plus interest.

This is to say that actual cost of service is even worse than it looks due to the necessity of relying on emergency vets to plug massive hole in supply. This encourages individual practices to price discriminate by offering the same services on an emergency basis for much more which further decreases the already scarce vet hours for non-emergency situations.

All of this makes perfect sense from a market perspective but none of it was normal 20 years ago here nor in most of the world so its not fate its a scrape we have gotten ourselves into.

All that you are describing matches Sweden quite well. Still, my niece who lives there (and only barely counts as middle class, working at a burger joint in Stockholm) regularly rants about that she doesn't have the money to get care for her dog. Maybe she should just not have a dog.

Will say: In theory it sounds great what you are saying, and for many other areas of life it really is great (I've heard lots of storries from her indicating that it's basically paradise), but that doesn't take away from that people don't understand that having a pet is not a human right but a huge responsibility and a luxury that one needs to understand the consequences of having. Instead of crying for daddy/the government when things inevitably come around that were not in the rosy picture when that puppy looked at you.

> Instead of crying for daddy/the government

This is a weird way to say work together to lay the groundwork for a more functional society. Accountability and recognition that are society is ridiculously poorly constructed are complementary not contradictory. It's humorous that you use as an anecdote your "barely middle class" niece and her complaints devoid of context whereas someone working at a burger joint here might not be able to afford to live inside. Over here she would probably either work a second job or her and her pup would live in her car.

The biggest first step towards sanity would be no longer issuing government backed loans for 400k, making pricing requirements and capacity goals based on prior performance to qualify for one thin dime. They might find the will to fire some of the useless expensive staff that aren't actually teaching kids. do a lot of the basic crap inexpensively online, and kick sports to the curb.

Currently we live in a completely broken market that is literally cause by the distortion of uncle Sam's unlimited funds on the educational market with no concurrent regulation to keep it from blowing everything up. The result of a minority of rich fuckers crying to big daddy government.

> > Instead of crying for daddy/the government

> This is a weird way to say work together to lay the groundwork for a more functional society.

I see where you are coming from. You don't need to convince me that the U.S. society with its bizarre incentives is deeply broken. I'm all for strong societal support.

But you also need to realize that offloading lots of responsibility to the government (and thereby the rest of society) has real drawbacks. Sadly many people either take advantage of it (in a bad way) or are just so careless that it just leads to overall worse outcomes. That needs to be acknowledged if you want to discuss fundamental rules for a more functional society. We can't ignore those effects.

I again was never suggesting societal support for veterinary care. I was suggesting we fix our broken educational system. You mention that offloading responsibility to the government has real drawbacks. We are already experiencing those drawbacks. Again empowering people to borrow hundreds of thousands of dollars of uncle sams money distorts the educational market and massive debt beyond what is profitable is hurting our supply of vets which is directly bearing on the cost of service.

If food could only be purchased with food stamps and there was societal pressure to offer more and more money indefinitely even if for all the best reasons one would soon find that a can of corn cost $12. Any complaints about regulating grocery stores in such a broken market entirely miss the point. There was never a functional market in that instance to protect. We should either stop pouring in billions or we should put stipulations on performance and price. Doing nothing until the can of corn is $15 doesn't seem tenable.

I could see an argument for that. If society is already paying high costs in order to prevent poor mental health and loneliness, pet ownership may be a cheaper solution in some situations than letting people fall into worse conditions that require time off work, pills and therapists.

A cost-benefit analysis could try make a reasonable argument for subsidized animal welfare.

Anyone who has to say ‘from a place of priviledge’ over a comment like that is just being an asshole. Which is what you’re doing.

If you can’t afford to take basic care of a pet, don’t get one. Period.

Life is already harsh enough to not add more misery to it for someone else.

Many "pets" are just farm animals. Nobody will fork out day wage to save some cat, that is catching mice at barn.

Unclear to me why this is being downvoted.

Caring for a pet has a cost. The obvious cost is its nutrition, but its health costs must be accounted for as well in the decision to acquire a pet. No matter if you pay a lot for the pet or get it for free, now you have full responsibility for this life. It lives in your captivity, so it's your responsibility to ensure it's being cared for. This is not nature, it can't just live on its own and take care of itself as it would do in nature. It's essentially your prisoner, even if it's rare to see anybody understand that, so you need to provide to its needs. Including health needs. And that incurs a cost. Not _if_ it's needed, it's _when_ it's needed. If you can't "swing" that, then your decision to own a pet was an unbelievably irresponsible one.

The hate shouldn't go towards the vet charging that money for treatment, but towards this irresponsible pet-owner-who-shouldn't-be-one. It's irresponsible mainly towards the pet, but even towards the vet, as the original article demonstrates quite well.

Perhaps it's downvoted because its facile and ill considered. Its locked into a tiny figure because the parent poster threw it out but in actuality vet emergencies are now mostly $1000-$2500 which exceeds what 57% of households can afford and pets can live 20 years.

https://fortune.com/recommends/banking/57-percent-of-america...

Ordinary responsible people are going to find themselves deciding what care they can provide for their pet both because of financial challenges personal and societal that weren't evident when they got the pet and because its getting expensive as fuck.

To be fair the price of education is limiting our supply of vets drastically to the point where every vet is booked to hell and back and can't see your animal on an emergency basis whereas the emergency vet is $500 to walk in the door and frequently $1000-$2500 wherein "emergency" is herein defined as something your animal needs to be seen this week for not next month.

Telling people you need to be middle class in America today to have a pet seems fairly inadequate.

Most americans cant afford to miss one paycheck. Should most americans not own a pet?

You seem to think people are going to cower in fear at giving the socially unacceptable(to a specific kind of person) answer here.

Yes obviously people should not buy things they can't afford. If that means you can't have a pet or a 90k pickup truck, or the shoes you want or whatever then so be it.

Totally bizarre that you see this as some sort of gotcha to phrase it this way

>$10k is nothing if you making half a million dollars a year and have $200k in credit with no balance, because your disposable income is probably $400-450k/yr.

You must mean half a million after taxes.

People have no clue how much tax cuts out at higher income rates.

And food, mortgage or rent, utilities, …

Man, this thread is a mess

There are a lot of people on this very site making 500k+ pre-tax. You're going to be taking home 300ish after taxes in that case, and it's not entirely unreasonable to "only" have 150ish for savings/investments/disposable income after your housing and living costs are taken out of that

If someone has $12k+ to spend per month and won't spend $10k to save their pet's life, they're an asshole IMO

I agree that people complaining about the higher tax brackets are oblivious at best, but I'll add that there's no income test to post here. I feel like I do OK (especially given that I have a job that doesn't require the sale of my soul), but it's far from 500K lol.

You should go get that money, dude. Life's too short to waste it all working

Pick a FAANG you don't feel too bad about, hit the LeetCode hard for a few months, then go work there for 5 years. You can save up $750k+, which is enough to leave Silicon Valley and eke out a barebones retirement somewhere in the real world (~$30k/year at a 4% safe withdrawal rate)

> hit the LeetCode hard for a few months, then go work there for 5 years

lmao

> $10k is nothing if you making half a million dollars a year and have $200k in credit with no balance, because your disposable income is probably $400-450k/yr.

There is no way someone making $500k a year has $400k of disposable income. Taxes will most likely be $120k; and other expenses will take up a sizeable about of that income.

More likely that person will have $100k or less of truly "disposable" income. That $10k vet bill comes out of the budget for a high-end car, or out of the vacation budget, or a landscaping project gets delayed until next year.

This, BTW, is why people who "have money" either buy pet insurance, or put the pet down. Many people who "have money" only have it because they are very careful about what they spend it on.

That is where some of the frustration does indeed emerge - one vivid example involved refusing a $500 procedure from someone driving a brand new Tesla.

Absolutely. Any time we have a routine visit, e.g. shots and a checkup, it costs us about $300. I can't remember a single vet visit we had that was less than $100, and we haven't had an emergency visit in years. I have no idea how most people afford it, I assume they just don't take their pets to the vet.

Vet costs vary wildly across different regions.

I just took my cat in for an emergency (little idiot ate plastic and we had to see if she had a block in her when she was continuing to vomit blood) and got her examined, a shot of anti-nausea medication, imaging of her gi tract, and some bland food to take home (which had to be special as she's allergic to chicken protein) for $215. I thought that was pretty damn reasonable honestly.

Private equity is taking over vet clinics. In areas where they have the market locked, they raise prices

I just did the same with a dog maybe a week ago. It was a little over $600. I'm in the exurbs of Chicago.

I'm in mid-MI, so I'm not even that far away. Crazy how prices vary.

> Can you not see how that would be viewed as insanely predatory?

I assume you must be an expert in the cost structure of operating a veterinary practice in that location, at that time, in order to determine a predatory and non predatory price.

If you are not, I am not sure how you can make any claim about the prices.

>For profit companies should not be involved in human or animal medicine.

What kind of quality of life do you think veterinarians and doctors deserve? Should they be able to buy a Mercedes? C Class or S Class? Should they be able to buy a home in the better school district? How many square feet?

These questions are relevant for determining the predatori-ness of the doctors’ prices. Even more relevant is whether or not you want the top caliber people spending years studying one of the most complex machines. Or they could go study how to deliver ads to people.

Frankly, if a vet can, as a matter of practice, afford to do procedures probono but only if the owner surrenders their pet, it means they are making an absolutely staggering profit from those who are emotionally extorted to pay. That is predatory.

I miss the days when vets got into the business to run small practices for a reasonable profit and middle class lifestyle. Few of them wanted mercedes money . It's kind of gross to think modern vet medicine is making vast sums off of pet owner's worst days.

Surrenders their pet to someone who can pay

You sound like you don't personally know many vets, you don't know what it was like to operate a vet practice back in the day, and you don't know what they drive.

I do, and going on about this (incorrectly) on an article about a veterinarian suicide crisis is unseemly. This isn't about you. If vets are so greedy and amoral, why are they committing suicide, for all the reasons listed in the article, at 4-8 times the rate of the general population?

You might find it interesting and beneficial to learn more about this topic firsthand. Vet practices, shelters, and vet schools often operate in coordination and are always looking for volunteers and donations. You may find more understanding and empathy with more exposure to the people this area.

You think you should dictate the price of someone else’s labor, and that is less predatory or somehow better than someone being able to price their own labor?

I can't 'dictate' anything. I just think that healthcare, for both humans and animals isn't the place for a 'the price is whatever the market will bear' mentality. That mentality assumes the participation of cool, rational actors. People making healthcare decisions for their family or pets do not fit that criteria. I feel it's immoral to use the love one feels for their pets to extract as much as possible from the owner.

I understand you probably feel differently. Frankly you and I will probably not ever agree on this topic as we have different world views.

Me myself? Absolutely not.

But yes, labor should have some means to be controlled for price, so that people cannot be underpaid or overpaid (as many are).

What is the formula for determining underpaid and overpaid?

The formula is what the master says you get paid.

"Tell me how to create a perfect society right now, otherwise you cannot critique this one."

You proposed implementing price controls to “appropriately” allocate society’s resources.

Unless you have specifics, what value does your proposal have? It is trivial to wish for world peace.

Did I wake up in another world where this is a legislative body? We're all just posting our opinions. Just because you don't like mine doesn't put a higher burden of effort on me to post.

I'm sure no amount of specifics would convince you that's a good idea, just as no amount of your specifics would probably convince me otherwise. And that's fine.

I am under no obligation to provide you "value" in my posts.

"Hey, you can't afford to care for your pet. I'm willing to spend several thousand dollars of my own money, but there's likely more care in the future, and I'd like to ensure the animal then lives with somebody who can afford any future care"

"You predatory monster!"

Do you think even for a moment through what you're saying, or is this just reflexive on your end?

Also, in what world is a median annual income of $100k, for a job with expensive and long training, "mercedes money"? If you have actual evidence of most vets making "vast sums", maybe it'd a good time to share that.

If you are referring to the story in the article then I believe you misunderstood. The vet didn't perform the procedure pro bono; the owners gave the pet up to someone who was able to pay for the procedure.

I don’t know a single vet that drives a Mercedes. I know a lot who drove beat up trucks and have a mountain of debt.

* FTC acts against private equity firm's acquisition of veterinary clinics[0] * Private equity is buying everything from vet offices to tech conglomerates [1]

I'm not opposed to people making money and having a comfortable life, but the fact that private equity is capitalizing on vet clinics is telling.

[0] https://news.ycombinator.com/item?id=31728350 [1] https://news.ycombinator.com/item?id=36313967

Private equity companies frequently purchase struggling businesses, not prosperous ones

Maybe, a local monopoly could be a cause for concern. But is the barrier to start a veterinary practice so high as to grant them a permanent monopoly?

In this specific case being discussed, it does seem the vet business was acquired by a PE company a few years ago:

https://www.mainebiz.biz/article/portland-animal-health-star...

Note that the vet doctors themselves may have ownership in the company itself.

The other option is that advanced surgeries for animals are so costly, and the proportion of people who have the ability to pay so low, that there does not exist sufficient demand for a new vet to want to open a new hospital. In short, pet owners simply cannot afford all the pet healthcare they want.

> I assume you must be an expert in the cost structure of operating a veterinary practice in that location, at that time, in order to determine a predatory and non predatory price.

You don't have to be an expert when you can compare vet prices in US and in other parts of the world. And unlike human healthcare, vet is not subsidized anywhere, so the comparison is fair.

With the price tag of 10K$ I'd say it would be worth to take a flight to Mexico, other LatAm countires, or even Eastern Europe to pay tenth of the price for the same operation.

Comparing prices in different locales makes no sense, especially in an un-arbitrage able scenario like time sensitive emergency surgery.

What if tort costs are higher in one country than another, requiring higher insurance premiums? Real estate is more valuable, resulting in higher rents/mortgages? Labor costs higher due to more stringent labor laws/less supply of labor. The list goes on and on.

I considered this for my pet's medical care. I did some things at a very expensive private equity owned bay area vet clinic, and other things at a much cheaper location quite a drive away. The bay area clinic wanted 4x as much for a relatively routine procedure. But they also had new and more advanced imaging equipment and monitoring equipment, and veterinary surgeons with fancier degrees and specializations.

I wholeheartedly disagree. After seeing the prices of basics like saline in hospitals, I'm not surprised to learn of inflated prices obfuscated from the general public.

That one is obvious due to us knowing the hospitals sell to the government and insurers for much less.

As far as I am aware, this does not apply to a veterinary business. The article also says it was $10k for emergency services at a vet hospital, including the aftercare.

What are the labor costs of having highly qualified people, presumably in low supply, on call to provide these services? What are the costs of supplies like medicine, and malpractice insurance (if that applies)?

The vets that I've been too (minus a non-profit clinic I went to once) absolutely charge outrageous amounts for saline and other things. It's a hard business, so like most time-of-use sales points they take advantage and charge for the convenience. I'm not making a value judgment, just pointing out that it definitely is something they do.

What is definitely something they do? Asking for higher prices in high demand low supply scenarios? That is something (effectively) everyone does.

It is how the world works. It is the mechanism which the markets use to signal more supply of something is needed (or less demand).

If you want me to study advanced biology for 10+ years and then have me work at odd hours of the day and night to be ready to perform surgery, you need to pay up, or reduce the other options I have for earning money which give me a higher quality of life.

Again, I'm not making a value judgment (as rationalizations from both perspectives can be made, and a person's opinion will depend on their perspective), just saying that "charg[ing] outrageous amounts for saline and other things" is definitely something they do. In a free market system they're allowed to charge whatever they want, and the consumer is allowed to take it or leave it. But explicitly stating the practice is a fair thing to do.

How much of that 10K would be Mercedes money ?

It goes without saying that a vet should have higher than average income considering the length and cost of study and responsibility etc. Not at all trying to say that they're greedy.

Not sure why this goes without saying.

More training. More required expertise. More investment - opportunity cost, schooling, etc. The mental/emotional burden.

Because in the US, higher education is largely a personal investment against future earnings, and vets have longer and more expensive education requirements that most jobs, so they need to have higher salaries to justify the initial investment and to incentivize people to pursue that career path.

Non predatory thing then is to help the owner to put the pet down painlessly and quickly for reasonable price. Without guilting the owner into 10000 operation.

I do not see any evidence of guilting.

> The incident involved a four-month-old German Shepherd puppy who'd swallowed a skewer and needed emergency surgery life-saving surgery. The cost of the complicated procedure and after care was close to $10,000 – more than the owner could afford. As a last resort, to avoid euthanasia, the clinic offered her the option to surrender the puppy to a new owner who could cover the cost.

What is a reasonable price? Unless someone is familiar with pricing from multiple vendors for some period of time, how could one know a reasonable price?

Is a million dollars a reasonable price? The point I make is that you might not be able to tell a reasonable price, per se. But you can generally tell an unreasonable price. It's some x-rays, animal quality anesthesia/meds, and labor. It's hard to see how this reasonably adds up to $10,000.

Were time not an issue, they could probably take a trip to Mexico, get the operation done for maybe a few hundred dollars, and come back home, all for much less money than the vet was asking. And the reason I think that's particularly relevant is that it's not like the underlying costs really change. It's like what led to the creation of SpaceX. Elon was wondering why it cost billions of dollars to launch a rocket to space whose materials cost a negligible fraction of that. And it turns out there was no answer, which is why SpaceX dominates space launches now.

> Is a million dollars a reasonable price?

If you can’t find someone else to sell to you for less, then yes. Barring broken markets such as due to regulatory capture, etc.

> The point I make is that you might not be able to tell a reasonable price, per se.

>But you can generally tell an unreasonable price.

These strike me as conflicting statements, otherwise I don’t know what per se means.

https://news.ycombinator.com/item?id=37846041

> And the reason I think that's particularly relevant is that it's not like the underlying costs really change.

>So developing world costs tend to give you a 'raw materials' cost, where all that's left is labor + profit.

Why are labor costs not underlying costs? How about liability insurance? Real estate?

Markets can break not only on the supply side, but also on the demand side. When consumers become unaware or uninterested in the baseline cost of what they're purchasing (or in econobabble - when the price elasticity of demand approaches zero), you end up with grossly inefficient markets because companies lose any incentive to meaningfully compete on price.

The point of looking at 'raw materials' cost is that if the costs on top of said raw materials becomes more than the cost of doing business elsewhere (such as in a different country), the one would be wise to do just that. This is the whole reason things like medical tourism exists.

It's not like other countries are getting their machines, medicines, and so on for that much less. It's just they're able to reduce the cost of everything on top of raw materials to the point that one can afford to take a 'holiday' half way around the world, get their issue fixed, and make it back all for less, often vastly less, than it'd cost to do stateside.

I have to imagine that a skewer in the squishy parts could result in a wide range of potential injuries. Maybe the specific injury here was just an “x-ray and pliers” kind of job as you suggest, but suppose this particular skewer skewered one or more organs, or resulted in some kind of awful hemorrhage or something. I could just as easily imagine the sort of injury that would require intricate surgeries and a lengthy hospital recovery, implying the round-the-clock attention of a number of specialized humans with mouths to feed and other career prospects (including patching up human animals instead!).

Euthanasia might be the only humane option in an x-ray-and-pliers outfit not staffed and equipped to perform such an heroic sort of intervention in the timeframe it would take to succeed.

One thing that does stand out to me is the extreme shortage of people willing to become veterinarians, even at these prices. It seems like regardless of the pricing on the retail end, capable young people considering modern veterinary life are sizing up the entire financial, emotional, educational, and lifestyle bargain and not finding the payoff to be worth it.

That said, I am sympathetic to the idea that modern veterinary practice has strayed too far from the way it’s done in lesser-resourced settings. Maybe it is more appropriate to set aside advanced and expensive medical techniques in favor of more cheaply-educated practitioners, more conventional business hours, simpler tools and supplies, more frequent recourse to euthanasia, and so on.

The blessing and the curse of modern medicine, no? It’s bad enough to have to face death when it feels inevitable, when “all that can be done to save them” is relatively simple and well-understood. Knowing that the same situation might be survivable under different circumstances—with more money, or in a place with the right practitioner, or if we’d just had this particular exotic antivenom in stock, or if the line had been shorter that night, or if we could hire some bioengineers and a lab to custom-tailor a treatment to puppy’s genes… the same death then comes with a lingering feeling of guilt over the possibility that more could have been done.

You're creating a false dichotomy. Animals swallowing things, being hit by vehicles, attacked by other animals, jumping from 8 story buildings (and living), and so on all cause similar groups of internal injuries - often life threatening. Yes it requires expertise and work to treat them - that's exactly what the job of a vet is. It's not like you go to a vet in the developing world with a puppy suffering severe internal injuries, from whatever reason, and they just shrug and ask if you want to euthanize.

Quite the opposite I expect you'd see dramatically less euthanasia in the developing world (though a quick search unsurprisingly turned up very little in the way of data). But I think the logic should be clear enough. Pets make everybody's lives better and more enjoyable, but very few people could afford to even think about dropping $10,000 on a puppy. Those prices are just a fast-track to mass euthanasia and depressed vets.

> It's some x-rays, animal quality anesthesia/meds, and labor. It's hard to see how this reasonably adds up to $10,000.

You should open a vet office then. Sounds like you’re well equipped to undercut competition and still make a hefty profit!

Or maybe you’re just making things up. Because we’re talking about an emergency open and close surgery to remove what’s probably a long sharp object with puncturing of the stomach. On a small animal. On immediate short notice (cancel everything else!). It’s going to be difficult with multiple doctors. And it’s going to require a lot of post surgery care.

My partner and I have a number of animals and volunteered at a shelter for many years pre-pandemic. We worked with vets and vet techs and are roughly aware of the associated costs.

$10,000 feels high at first glance but consider the size of the skewer compared to a small animal. There is likely damage done to other areas including major internal hemorrhaging which is not super straight-forward to track down completely (even in humans). If the skewer was single-use bamboo (which I suspect given how much wood will retain food smell and how puppies love destroying garbage cans), the puppy would have likely chewed on it a bit causing splintered mess internally.

This would result in a multi-hour procedure with at least 2 surgical staff (surgeon and tech) and anesthesiologist (due to the complicated nature of this, we can’t have the animal regurgitating as well as active life support monitoring). In addition to the standard tools, they would be using X-rays, dyes, internal (dissolvable) sutures, etc. Internal organs would be mended, stomach fluid would need to be removed from the abdominal cavity, and there would be at least 12 hours of monitoring post op.

Expensive, yes, but I don’t think it’s that unreasonable unfortunately.

I think your guess here is pretty much spot on.

TFA links another article explaining the $10,000 bill is a combination of $3,000 of completed tests the original owner had already paid, the surgical procedure, and aftercare costs.

TBH, the only part of that which sounds high is the $3k for pretests. But I don't know what all had to be done, so I'm just guessing.

Also, as for "Once that cash cow is gone maybe vet school prices will come down to earth." - the source of the rising cost is a combination of two things, neither one of which has anything to do with small animal medicine:

1) The loss of industry support for large animal vets

2) The loss of state funding for veterinary schools, which has put pressure on the one remaining dial available to those schools, which is tuition. This is a systemic problem that extends way beyond vet schools, but is particularly obvious there

What caused #1?

Also, regulatory and insurance capture.

If anyone could perform veterinary medicine out of their garage, I imagine costs would come down significantly.

> no matter how much they are loved

I don't buy it. If their kid needed a couple thousand dollars to live, a lot more people would be able to scrounge it up. If they can't do the same for their pet, maybe they actually do love their pet less ... and that's OK.

There are a lot of people who wouldn't spend a couple thousand dollars to save their own lives, let alone their kids. People get hit with thousands of dollars for their kid because once it gets bad enough, the system takes over and stick you with the bill. If people got a choice, they would not always choose their child. I can guarantee you this. We can see this where parents do get a choice: dental and vision care. There are a lot of kids suffering and going without because of a few hundred dollars.

> If their kid needed a couple thousand dollars to live, a lot more people would be able to scrounge it up.

While I agree that many (most) people would make it work if it were for a child, I wouldn't use the insanity of the US's human healthcare bills to justify anything. It's also insane and a travesty that you can walk into your hospital and walk out with multi-thousand dollar charges you cannot pay. Both can be terrible and unjustifiable.

Your child is very likely to outlive you. In fact, to some, this is a major reason to have children.

On the other hand, your pet will die in your lifetime, unless you are very old or die unexpectedly. So most people are probably prepared for this emotionally on some level.

Emotional attachment does not mean that human is not able to do rational decision. No matter how deep I love my dog, I do not have the same responsibility toward him then toward my child.

Replacement cost is less on a pet.

Yes of course! Remember most of us have dead animal remains in our fridges. Ethics is a complicated subject!

> The truth of the matter is that most people cannot justify spending thousands of dollars on a pet, no matter how much they are loved, and that DOES NOT make them bad or unfit owners.

I'd argue not having the means to deal with emergency situations would make someone unfit to own a pet.

I get that circumstances can change and costs increase, but I also feel too many people assume a pet doesn't cost much or isn't much of a comitment.

You're right that the costs are crazy, and not taking it into account when deciding to take or keep a pet is irresponsible.

So every pet owner without at least $10k set aside for pet emergency care is a bad owner. That describes 99% of pet owners.

I agree people should plan for more pet-related costs than they do, but, as technology progresses, there doesn't seem to be a ceiling on the amount you _could_ spend to save a pet.

In my case, we have always taken in rescue animals. So the choice is between leaving the pet at shelter or a life in a good home with some limited options when it comes to end-of-life care. I think the latter option is more humane.

There are pretty decent pet insurance policies responsible pet owners could purchase and pay a monthly premium on. I've used it for my past two dogs and it has been painless and easy to use when I needed to.

So it isn't a big $10K+ or bust argument. But the sad fact of the matter is very few pet owners assume ownership while planning for the potential bad days and the extra financial burden and responsibility that they should feel when they take on pet ownership.

I come at it from the angle that taking in a horse will costs you inordinate amounts of money upfront, and people are generally ok with it, and won't be crying to get a poney when they're already struggling to pay a mortgage.

If in practice owning a dog or cat will also cost 10k at times, it's only reasonable to take the same approach and consider owning a them as a pretty high luxury, until the costs effectively come down.

Or every pet owner gets to your level of dedication and will assist their pet and the vet when tough times come and hard decisions need to be made. I personally wouldn't have the guts so I'll stick with my goldfishes.

I agree that people shouldn't adopt a pet unless they have stable finances which are enough to pay for pet insurance and/or unexpected vet bills.

Sometimes people's finances change though, and then (assuming it wasn't serious money mismanagement) I think it's cruel to say they should give up their pet.

Pet insurance should be front-loaded, so you have to pay a lot the first few months, but if you stop paying you get to keep the insurance at least for a while.

I had insurance for years and it did me no good, they refused to cover a single dollar of expenses even though I had the best most comprehensive policy I could find. This has been my experience with insurance in general. Even in cases where you read the fine print and have all your paperwork in order, they just deny all claims period. Collecting on insurance requires being ready to go to court.

Pet insurance is basically the opposite. Most people get it when their pet is young and the premiums for young pets are reasonable and low. Then, as the pet ages, the premiums go up and up.

And once you have any vet record of anything other than a routine wellness check, you're basically locked into your policy because if you try and switch providers, you'll run into pre-existing condition limitations, which are quite difficult to understand or predict. This is also difficult because not only will your insurance go up simply for your pet getting older, the pet insurance companies are constantly going through rate changes, as they adjust risk profiles for breeds or adjust to vet care inflation. Depending on what state you live in, these rate adjustments could be completely uncapped.

Even if you don't switch, many insurance providers won't write new policies for pets over certain age thresholds.

We already have a crisis of homeless/stray animals out there. I can't imagine how much worse it would get if we only allowed the 1% of the population with $10,000 or more to spare in case the pet needs surgery to own pets. Also suicides will go up. Pets are an important source of companionship and oxytocin/closeness for people who live alone.

This is a good point. Perhaps the direction should be more about subsiding pet care cost and moving towards fonancial support as part of the humans' medical insurance ?

Basically pet ownership would require either 10k on the side or registration and justification to get proper insurance.

Personally, like it has in the human medical world, I think pet insurance is increasing vet costs too. Used one clinic for years and they had reasonable (if slightly high due to being a 24 hour facility) costs. On year they suddenly start advertising pet insurance, and "for some reason" every service "covered" by the insurance went up in price.

Medical insurance distorts the market by disconnecting the payer from the costs. It will do the same in veterinary medicine if it hasn't already.

Or we accept that sometimes pets die and that if the operation costs 10000 then fit owner can still decide for the pet to die.

That goes for fish, dogs or tarantulas.

We're back to the article situation though, the with owners being bitter and unsupportive and the vets in depression and suicidal.

Compared to animals in the wild, or animals we raise for food, our pets have it pretty good, even if we have to put them to sleep rather than pay an expensive vet bill. A painless death at the vet seems like nothing comparatively.

For pets, "means to deal with emergency situations" includes euthanasia if the procedures required for a cure are too expensive.

There doesn't exist a duty to spend unreasonably large quantities of resources on saving any particular animal's life, so not being able to afford that doesn't make someone unfit to own a pet. If a pet has cancer, it's okay to perform a complex surgery that could save it, but it's also okay to let it die.

That’s nuts. My dog is awesome, but I’m not dropping $10k on the guy.

Animals aren’t humans. We do the best we can.

I have yet to see evidence that it's out of whack. Vets are are doctors, have to employ staff, and have training, processes and tools analogous to human medicine.

There's no vet industrial complex, so no administrative/insurance/legal parasitic overhead like in human medicine (in the US).

No, but costs are artificially higher than they need to be because the government restricts who can go into business by requiring advanced degrees, and the schools that provide those degrees make a lot of money doing so. It's certainly not an industrial complex anywhere near that of people medicine, but it's definitely out of whack thanks to regulatory burdens.

I personally agree with the government that you should probably have an advanced degree before being allowed to cut into or administer drugs to a living creature.

I'm by no means advocating a YOLO approach of no requirements, but there's definitely unnecessary bloat in the requirements. Just looking at the incentives, the people who make the rules benefit financially from making those rules as arduous and all-encompassing as they can get away with, and in order to become a rule maker you have to be fully in the system, so it's a positive feedback loop. The same mechanism can be seen with licensing rules on haircutters and stylists.

Why? The effect of that is that it becomes too expensive to treat that living creature, so it gets euthanized instead. Or just let the creature suffer until it dies on its own.

I would rather euthpanize my dog than subject it to quack vets.

And you think everyone should have to make that choice? And that e.g. 4 years for an undergraduate degree isn't enough to become proficient in treating cats (at least for the stuff that's worth treating)?

This thread has become casually dismissive and insulting to the actual work that vets do.

Techs (for states that require technician certification, it's a two year degree) do a lot of the work with pets. There's often more than one technician per doctor. That reduces costs. Doctors are still needed because, unsurprisingly, cases can have a lot of nuance that requires significant training to see.

That's fine if people want the best care for their pet, but not everyone is going to care about getting that level of service. I've taken in multiple strays over the years that found their way to me. Shelters where I lived were already overcrowded. The counterfactual was likely that they get hit by a car or caught by the city and euthanized.

I'm sympathetic toward animals, but there's a lot of them that are lucky to have anyone take them in at all, and a lot that aren't that lucky. If someone wants to get an animal some level of care without there being someone with a postgraduate degree to supervise (instead of no care), that sounds like a good thing. They could always be referred to a more qualified vet if needed.

Doctors are not need or wanted by everyone. I would go to an unlicensed vet for cheaper 10/10 times.

For the routine tasks, eg flea medication or bloodwork, a vet isn't helpful. For difficult tasks like surgery, a vet is too expensive.

I'd rather use a quack in every case.

The good news is that nobody would force you to. They could go to quack veterinarians and you could go to certified ones.

>There's no vet industrial complex, so no administrative/insurance/legal parasitic overhead like in human medicine (in the US).

You obviously haven't seen where private equity has been buying up private vet practices

I would question that second assertion; given the rise of pet insurance, private equity buying up clinics, and the increases in cost of veterinary care entirely out of line with inflation, my suspicion is that we're in fact in the early stages of the buildout of a vet industrial complex.

Seems like the usual suspects have realized that there's a ton of money to be extracted by the veterinary industry and we're seeing the direct (hey, our CFO did some analysis and we can raise prices 500% and only impact sales 20%!) and indirect (hey, since there's a lot of money in this industry now, we've developed a new veterinary surgical instrument that improves outcomes 10% for only 20x the cost!) effects of that process.

And in this case, veterinarians are caught in the middle since they don't have a powerful cartel to protect them like human doctors; they end up with all of the stress and none of the profits.

"given the rise of pet insurance, private equity buying up clinics, and the increases in cost of veterinary care entirely out of line with inflation, my suspicion is that we're in fact in the early stages of the buildout of a vet industrial complex. "

In the last few years have seen several times how things go when private equity buys a dental or vet practice (or even plumbing) . The workers there are suddenly under a quota to make money, have less time but more stress, costs to the customer go up. The only beneficiaries are the private equity company. Everybody else loses big time.

It is worth adding the drug companies and their lobbying groups to that list.

As much as I wish that were true, it isn't really true. There is definitely a complex of businesses behind veterinarian offices with the intent of driving up prices.

>and then pressured the owner give the pup up when they couldn't afford that

My wife is a vet and I hear about this often.

From the vet's perspective, if the owner gives up the puppy then they don't have to put the puppy down. Putting down a puppy is heart-wrenching.

You can't give out free medical care, she regularly gives as many discounts as she's allowed to give away, even some she's not supposed to, especially for cases like that. But in the end, the choice is A: put the puppy down or B: do the procedure for free but then the owner has to give up the animal.

When presented that choice it's obvious you should try and convince the owner not to put the animal down.

Why is it like that though? Like what are the economics of performing the procedure that it's possible for it to be free if the owner gives it up? Does someone different ultimately foot the bill?

I can't see it as anything other than emotional extortion. It's not like the animal shelter is paying for that care. It's being written off, and the reason it's being written off is they make so much from the owners that do pay they can afford to do so.

From a microeconomic perspective (which is also my own), I agree completely. I am trying to consider the macroeconomic perspective as well though, which quickly spirals into bankruptcy if they just start doing treatment for free for people who can't/won't pay for it. Unless/until we make it easier and cheaper for people to go to vet school, they have to make money.

It is NOT being written off. It is being paid for.

It wouldn’t make any sense otherwise. It would be a lose lose for an animal shelter to receive this deeply fragile animal and the vet to do this expensive surgery for free.

Who do you think is paying $10k for this pup?

The people who get the pup. That is how it works. It’s not going to a shelter.

You can do this a few times, and sometimes they do actually just do the procedure for free and the owner gets to keep the animal. But it does not scale. As soon as it becomes a rule then it becomes abused. One thing you realize quickly when running a clinic that deals with the public is any rule/policy that can be abused, WILL be abused. People try all kinds of tricks to not pay for their bills. And the clinic has to fight a constant battle with Yelp reviews as well, which greatly affect their business. If someone gets free treatment for one animal but not another they will destroy the business with Yelp reviews.

You get a wide range of clients at a vet clinic, some people are very nice and deal honestly, but there are a ton of people out there, I would say they are "less than savory" characters who recklessly adopt a lot of pets (like 5 dogs, 5 cats, and no money to pay for any bills) and will abuse these policies all day.

The new owner pays for it.

How does that work, though? Is there a constellation of dog-seeking people hovering around veterinary offices that only want dogs that cost $10k and have recently had major surgery? People who are willing to donate $10k to save a dog's life but consider it very important that the current owner no longer have the dog anymore for some reason?

$10k means very different things to people of different socioeconomic statuses, but the new owner took a rinsing to keep this dog alive - german shepherd puppies from almost all breeders cost less than $5k.

Likely the vet simply knew someone with deep enough pockets who loves dogs and was willing to take one for a well above market fee. It doesn't seem unethical to me that person only wants to save dogs they own.

For a well-bred GSD, probably. Waits for puppies can be years, and cost thousands anyway. Paying a bit more in vet bills instead probably seems reasonable to the right owner.

This is going to change how I view yuppies who tell me they rescued their dog. Was the dog really owned by abusive people before they bought it? Or was the dog owned by a family that loved it but couldn't afford a $10k procedure? Is there a tactful way to ask?

I wish I didn't know such arrangements are happening.

Based on my experience with vets, a large percentage of the time it ends up living with the vet.

Every single one I know has a small menagerie of broken animals.

In the case the article mentioned, yes. The vet found someone willing to adopt the puppy and foot the bill for the heroic intervention.

Who are these people who want a puppy but instead of getting one for $60 at a shelter just wait for the chance to pay $10k to take one from its owner?

At my wife’s clinic they have shelters that pay for the procedure on condition of taking the animal.

Like there is a shelter in the city that will pay for medical bill and take the dog.

I do sort of see the logic. Part of responsible pet ownership is being able to keep your animal alive and healthy, if you don’t have the resources to do that then you maybe aren’t ready to be a pet owner. They make insurance to cover this exact thing, called pet insurance. If you can’t afford to have pet insurance and you can’t afford to pay for the medical bills then you can’t afford to have a pet. There are other people who will provide the care that the animal needs, but at that point they will become the owner.

I understand that this sounds heartless WRT the owner, I didn’t make these rules this is just how it works at my wife’s clinic and that’s the justification I have heard from the shelter and the company that owns the clinic.

Why does the owner have to give up animal in that case? If its to prevent people from casually claiming they are unable to pay for treatment then why is putting that animal down for want of treatment something that they do?

Not trying to hold you accountable for the practice of course, but it seems like you might know

> …do the procedure for free but then the owner has to give up the animal.

Why go through the trouble of rehoming the pet when it already has a home that loves it..?

Yeah it seems sort of like a punishment for being to poor to pay for the expensive vet care.

> You can't give out free medical care

Is this asserting a legal or professional requirement? Or rather a "rule of business"?

It's a basic rule of economics. Veterinarians need to eat too.

It is a rule for f business. If vets operated on a 'pay if you want basis' they would all go out of business overnight - tragedy of the commons and all that.

We have pet medical insurance. It’s about $30/month per pet.

If you can’t afford medical costs for your pet then your pet will die if something bad happens.

Likewise if you take some magical fairy “society owes me taking care of my pet” then you’re going to be as disappointed as if you walk into a Chanel store and demand a free purse.

Pets are a luxury, not a fucking right. It’s not anyone’s job to keep it alive if you can’t afford insurance or costs.

Check what that insurance actually covers and do the math on it, especially over time (and even factor in current interest rates) and considering total coverage along with deductibles. You might think that you're covered, but in reality you aren't.

I couldn't find any insurance that made better sense than just putting $30/mo into a money market account at 5.25%. The way the policies are written, they clearly are there to make money on people who are buying piece of mind comfort over looking at the reality of the costs.

It has worked out positively for us so far, but yes, even with insurance it doesn’t cover everything. My point was not “buy insurance”. My point was “pets are an expensive luxury”. Pets. Plenty of farmers with working animals, and you won’t find them here complaining, because they aren’t under any illusions.

In my specific situation, I would have paid less money with insurance for just the diagnostics, not counting any procedures. (For a 16 year old cat.) Definitely do the math, but emergencies and diseases of old age can become extremely expensive. You may end up never needing it, but if you do, it can really reduce your costs. Personally I now prefer to pay out the $30/month and be covered for costs exceeding that, than to maybe get to keep the $30/month in the end.

How much profit do you think is being made in that $10k skewer removal?

probably a significant amount, otherwise private equity wouldn't be buying veterinary practices all around the nation. I know that the service I receive at a veterinary clinic I used to go to has become worse, a number of vets quit and were replaced with new younger ones, and the price increases have drastically outpaced inflation. all after the original partners sold to private equity.

I don’t really know what the answer should be. I somewhat arbitrarily chose a vet, found the group they are a Bart of, and looked up their accounts up to autumn 2022:

  Turnover 987 =
    Goods sold 96
  + services 776
  + ‘health club’ 113

I didn’t look into the health club thing. I think it’s a subscription and it probably includes regular checkups, vaccines, and maybe some other random things.

  Staff costs 442 (50% of turnover)
  Lease payments 37
  
  Profit 69.3 (~7% of turnover)

I’m not very good at reading financial statements and I didn’t try to dig through all the costs. There are things like buying new equipment as well as things needed for each operation. The group spent 118m on buying up other practices, but I don’t know how much leverage they had. If we take those numbers in a conservative “what if they were trying not to profit” scenario where they have no leverage, that’s 177 in “profit” out of 987 in income, or about $1800 if you assign it proportionally to a $10k skewer removal (or $700 if the acquisitions are counted as free).

I don’t know how those numbers look to you. To me, they don’t seem insane and I’m not sure the difference would matter much — I doubt the person unwilling to pay 10k would be willing to pay 8.2k. Also, I would guess that sort of surgery to be lower margin than routine things, though maybe competition drives it the other way.

I've found most veterinary care and meds to be very affordable. Major surgeries or specialized equipment (for large animals like horses) can be expensive.

Yeah, the schools are going to be expensive just as colleges are. Similar to med school, you're looking at high costs of educators, equipment, etc.

They also cut costs when they can. Metronidazole for colitis as an example - it’s not the standard of care for humans, but vets use it all the time because it’s wildly cheaper (cents vs $100s for vancomycin or $1000 for Fidaxomicin)

Even when it's the same meds, it's usually cheaper for the animal form (especially antibiotics).

That puppy example is special. In many cases (most?) the fact that a pet needs more than $10k it is likely too much to put the pet through. No way I would give a dog chemotherapy for cancer for example

That's not a reasonable thing to say. "Giving chemotherapy" is almost as general as saying "giving medicine". A young dog with a treatable cancer is not going to cost anything near $10k and should get many good years of life. Some cancers (eg, mast cell) have glorified Benadryl as "chemo".

Just put in the effort to find a good vet, build a relationship, and trust them give you good advice.

I'm not saying this to you, but this has been a terrible post on HN to read, the worst of the community is on display. Lots of confidently wrong people that are very quick to see the worst in others.

> but vet costs are completely out of whack with reality these days.

This industry, like so many others, has become a target for venture capital and consolidation. It's very quickly on it's way to becoming monopolized. Which makes headlines like this to me very interesting, because I assume they're designed to push people out of the profession and practice ownership and just sell it out to a firm when they come knocking.

> For profit companies should not be involved in human or animal medicine.

What is self ownership but an attempt to earn a profit? The issue isn't attempting to earn, the issue is the attempt to fully monopolize the market. I wish people saw through this more often.

This is a very un-empathetic take towards people who spent many years in school, work very hard, and earn relatively little money for their trouble.

What do you expect surgery to cost?

It's not like it was 1/10th the cost a while back and has suddenly became exploited by Big Veterinary or something. It was always expensive and you just wouldn't even ask unless you were especially wealthy or were unusually willing to sacrifice.

What's changed (perhaps for the better) is the sense that pets are worth the sacrifice. If you're younger or from a more wealthy background, you may not have a good intuition how much more accepted it was that pets (and people) simply don't get all the care that they might. The idea that intense medical intervention is a right for people, let alone animals, is actually pretty new.

Vets are NOT being predatory just because their work continues to be expensive.

The last vet surgery I paid for was in Indonesia and it was like 100x. There isn't some law of physics that makes it cost that.

Do you know how much it costs to maintain and operate an imagining (MRI, X-Ray, etc.) machine? Do you know how much it costs to maintain staff (doctors, techs, office assistants, etc.)

As someone that used to think the same way as you, and then got to see other side of the business (my wife is a Veterinarian who runs an urgent care facility) —— it’s easy to think the way you do without seeing the costs incurred on the other side.

Shouldn’t we as a society front the cost for the services ? I guess, socializing pet care is going to be a far step behind socializing human medicine and that is still a hot topic.

There is enough wealth created in our economy to cover these costs, and more, but heaven forbid a company not make more profit this year than last.

Absolutely not, no. I can think of no basis to demand that non-pet owners pay taxes to subsidize pet owners.

What a silly idea. There is nowhere near enough money in the economy to cover these kinds of costs for pets.

Every dollar in the economy is only 70k/person and the government already takes 28k/person.

Why would I ever want to pay exorbitant prices for your pet. I don't even want to do it for mine.

Ridiculous entitled view. At minimum, vets have to do undergrad + four years of vet school. If you find a board certified vet, they will have gone through 1-2 years of internships, and another 2-3 years of a residency, plus board exams. Technicians in many US states have to at least have an AA degree, but the competition is such that many have Bachelors these days. I know of a few that even have Masters.

And a lot of drugs are re-purposed from human medicine. Syringes, IVs, antibiotics. The manufacturers are not giving vets a discount just because it's being used in a rabbit. You just never see those prices for yourself because insurance hides it. The vets have to pass it on to you because their business is not a charity.

If you don't want top quality care for your pet and you don't value the skill and knowledge of a trained professional, there's plenty of bargain basement vets that are willing to cut corners.

There are some items like medications and IV fluids rebranded for veterinary use. I assume it lowers the cost but don’t know for certain.

Here’s prior discussion of VC firms buying up veterinary practices, and installing new management to squeeze out more value: https://news.ycombinator.com/item?id=36313967

Many of the hard costs in veterinary medicine are exactly the same as human doctors. Rent is rent, stitches are stitches. Most of the supply chain is the same. So when they open a bag of saline, put in a line, gown up, open a pack of sutures, etc. those costs are exactly the same as a human doctor. Their ultrasound machine comes from the same factory as the one one at your obgyn. Equipping a surgical suite is an expensive thing.