Patients get charged $1000 for an ibuprofen based on a particular hospital's calculation at distributing costs across a variety of procedures, staff, and settings. However they distribute those costs, the costs must bear the expenses of physicians (who had to figure out whether you needed an ibuprofen or a cardiac catheterization for that "chest pain" and whose complexity of decision-making and time-cost is not diminished because the answer turned out to be muscle pain rather than cardiac), nurses (who administer the drug, and who aren't one cent cheaper because they were giving you ibuprofen rather than rituximab), attributed cost of auxiliary staff, and facility maintenance costs (it's a lot more expensive per square foot to get your ibuprofen in an emergency room than in a primary care center.) The result is that line-item billing usually looks wonky. That we offer line-item billing is a weirdness from our fee-for-service structure, not an actual recounting of the cost of giving someone ibuprofen. If the ibuprofen was listed as a buck, the 999$ would still have to be shifted onto another line-item. The costs have to be attributed somewhere.

And you know what? Everyone should kind of know this already. If you didn't think it required the urgency, staff, equipment etc. of an emergency room, you should've gone to a primary care physician. They would've gotten you that ibuprofen for pennies. That you go to an emergency room indicates there's something else you're paying for besides the ibuprofen.

(( On top of that, the expensive price is usually a chargemaster price for negotiating with insurers, not a price intended for human beings to actually pay. The uninsured get fucked by being input into a system that takes for granted that they are a highly uncommon component. ))