Whenever someone asks about the cost of an ICD (Implantable Cardiac Defibrillator), an image pops into my brain.

The image that I see is how the ICD gets handed to me during the implant surgery.

Imagine: Careful. Cautious.

Consider how you would pass your new brand new iPad 2 to a friend, then multiply that vigilance ten-fold.

Since that fateful day, the surgical techs in our lab hand me an ICD in a very distinctive way. They cup the device strongly in both hands, not releasing it until it’s well north of the surgical field. You could easily call this hand-off, reverent.

Like other ancient stories, this kind of reverence stems from the long-told story of the young surgical tech who once dropped an ICD on the floor. It happened many years ago, and now has become folklore. I was there that fateful day.

I remember the look on the face of the young technician. Like anyone who has just seen their hard-earned Apple product suffer the sequelae of gravity, she was immediately horrified. The color vanished from her face. Her vagus nerve spiked; she needed to sit for a moment, nearly fainting from the adrenaline surge. For on paper, that ICD-on-the-floor cost more than 30,000 dollars. A twenty-three year-old technician struggling to make ends meet considers that amount of money a life-changer.

But how much money was really lost when that titanium can of electronics bounced onto the unsterilized floor?

Was it like burning 300 one hundred dollar bills, or dropping 15 MacBook Pros?

I don’t think so.

What I tried to explain to that stunned young woman is the difference between the ICD charge and its true cost.

It’s true that the ICD-maker (I cannot remember which company it was) charges the hospital about $30,000 for the entire defibrillator system. The hospital then transfers that charge, plus all their other charges (medicines, OR time, recovery room time, monitors, EMR, business office staff, etc) to the patient. It ends up costing about as much as this…

What you believe an ICD should cost says a lot about where you might stand on the issue of spiraling healthcare costs.

Do you say that the life-saving device was worth only the few hundred dollars that it cost to weld the electronics together somewhere in a Caribbean island factory?

Or…do you argue that 30,000 dollars is appropriate compensation for the research and development that went into that (potentially) life-saving can? For the innovation.

(At least, we can all agree that marketing costs are lower–now that the logo’d pens are banned.)

But isn’t it fair to ask this question:

Why do the ICD-makers charge a hospital in France many thousands less than they do ours in Kentucky? It’s the same ICD, with the same research, the same engineering, and the same competition.

This week, WSJ opinion writers argued correctly that the average poor person in America today has access to better health care than the billionaire of the 1950s. They were reporting good news about the wonders of modern medicine. They concluded:

The main objective of health-care policy should be to maintain an environment and incentives so this progress can continue. The greatest tragedy of ObamaCare is that its taxes on medical device makers and others will slow that progress, while its price controls on insurance and medical providers deter competition and innovation. Yes, American health care is expensive, but the CDC report shows that its benefits include longer and better lives.

How much should we expect to pay for the innovation that comes with the fury of modern medicine?

That’s one of the fundamental question of our current healthcare debate. You will need to consult far smarter bloggers to get the answer.

Let’s just say, ICDs cost enough to be held reverently with two hands.

JMM