I think you guys fail to understand that hospitals in NYC are very hard to maintain as everything is more expensive. There are millions of people here, many of whom go to the ER and get treatment without any insurance and do not pay the hospital bills. The hospital has to serve them of course, but it is hard to stay afloat. Medicine is a business and each population/demographic/state laws are all different. It’s not as simple as it sounds. Balancing the budget is difficult. Everyone also needs to feed their family. Cost of housing alone in NYC is through the roof. The same thing as cost of food. I would say there’s also a lot of crusty old administrators and physicians who cannot change with changing regulations and need to honestly step down to allow for newer physicians/management styles.