ELI5 Why hospital budgets are so tight?

Buissnesses and industries across the planet remain profitable while marking up their products 10, 20, or 30% on the higher ends. Yet hospitals mark their services up by hundreds, even thousands. Far higher gross profit on those services than nearly any other industry on the planet, yet every time finance is discussed they act like they are among the poorest businesses on the planet, using that excuse to justify treating nurses and other employees like garbage.

So where the hell is the money going?