Wednesday, June 5, 2013

The Latest Villain Causing America's Exorbitant Health Care Bill Is The Colonoscopy?

Here we go again with the media, another expose for why medical costs are so high in this country. Earlier this year, Time magazine blamed expensive health care on hospitals and their trumped up, rarely enforced, charge master prices. They detailed a conspiracy theory of hospitals, doctors, and pharmaceutical companies all working in collusion to rip off the Americans and send this country to the poorhouse.

Now the New York Times has written an inflammatory story about the abuse that seem to permeate the health care industry. Under the headline, "The $2.7 Trillion Medical Bill" is the sensational subtitle, "Colonoscopies Explain Why U.S. Leads the World in Health Expenditures." Really? The humble little colonoscopy is the root cause of why the U.S. spends trillions of dollars on medical care? That seems to be quite a stretch.

I'm not going to go into the merits of the article and all its finger pointing. The gist of the story implies that greedy gastroenterologists have built these fabulously lucrative ambulatory surgery centers that can charge patients more for an endoscopic procedure than if it is done in a doctor's office. The newspaper also couldn't help dragging anesthesiologists into this tawdry state of affair by stating anesthesia really isn't necessary at all for a colonoscopy. We are only doing it for the money. Blah blah blah. That discussion has been ongoing since the invention of endoscopies so I'm not going to go into any more details. If you want to read the numerous posts this blog has done about anesthesiologists and endoscopies, just type "GI anesthesia" in the search bar on the right side of this page.

No, what caught my eye about this extensive piece of yellow journalism is one of the subjects who is profiled. In the very first paragraph, the paper talks about Ms. Deirdre Yapalater. She had just had her colonoscopy at a surgery center and was shocked to discover that the procedure cost $6,385. Further down the lengthy article (her story is scatterly randomly throughout) we find out that the cost was broken into $1,075 for the gastroenterologist, $2,400 for the anesthesiologist, and $2,910 for the facility fee. She had no complaints about the facility, calling it, "very fancy, with nurses and ORs. It felt like you were in a hospital."

The story reveals that she never wondered what the cost of the colonscopy was going to be when she scheduled it. She felt that since the insurance company was going to pay for it, why should she bother? It turns out she has quite a comprehensive health insurance plan. Though the newspaper describes her family as frugal, with stacks of water bottles piled up around the house with its dilapidated dining room wall paper and an anecdote about her desire to save on a $130 copayment for a dermatology medication, her family appears to have quite a Cadillac health plan. Their health insurance costs $35,000 per year, of which they have to pay $15,000. That is a huge chunk of change for an insurance plan. It's no wonder she didn't worry about the cost of the procedure beforehand. Her insurance is so comprehensive it pretty much pays everything, sparing her the need to further investigate costs. She paid absolutely nothing for her colonoscopy.

To me that is one of the reasons why we spend trillions of dollars on health care. When somebody else is paying for it, why bother shopping around? Imagine if the government or insurance companies bought everybody cars and all we had to do was contribute a small copay. Of course we would all want the best and most expensive care available, regardless of cost. Heck somebody else is paying for it. Why can't I have the best car in the world? Why can't my 92 year old grandmother have that Rolls Royce? I will sue if she gets a cheaper car and something goes wrong because nobody should be treated less than somebody else.

So now Ms. Yapalater is "stunned" that her procedure costs over $6,000. She laments, "You keep thinking it's free. We call it free, but of course it's not." Hello. why does she think medical care is free? Does she expect her food from the grocery store to be free? The gasoline in her two SUV's? Her summer vacation home on Fire Island? Yet somehow she gets it into her head that health care should be free for all. Now she's upset that her insurance premiums are going up by double digits every year.

No I don't blame the life saving colonoscopy for the entirety of America's health care woes. I do blame people who get it into their skulls that health care should be free for everybody. That nobody wants to pay for it even though everybody wants the best quality care available. And if it is not the best or there is an unanticipated outcome they will call the lawyers. But of course the newspapers can't write stories that might insult their readers. It is so much easier to put the blame on doctors and hospitals who can't truthfully speak their minds about what they think is raising health costs. But I just did.


  1. Let's just face it: the American healthcare-consuming public is rude, impatient and spoiled. Why pay an anesthesiologist when a nurse can push propofol? The intelligent rejoinder, "because once in a while you'll have a catastrophic outcome," is muted by the rarity of its occurrence and the bludgeon of an hypertrophied malpractice system.

  2. $2400 for the anesthesiologist? What Really? I want that job!!! I've seen hospital bills where the the hospital charged a huge fee for "anesthesia" and did not want to pay me the anesthesiologists because they had already paid the anesthesia fee. The hospital charged for equipment usage and drugs, and lumps it into "anesthesia".

    As for colonoscopies, I only get involved with them when either 1)the usual sedations has failed, 2) the patient has a drug history consistent with one who would be difficult to sedate, 3) a patient with many co-morbidities, (ASA 3+, 4) [is there ASA3+? ], 4)really young patients, or 5) patient insists on it. By far the majority of colonoscopies at our facilities do not have an anesthesiologist involved. $2400? Really???

    Colonoscopy as a life-saving tool - - eh. How many colonoscopies need to be performed to save one life? Statistics widely vary, but the number is 1:1,000 to 1 in 10,000. Perforation rates are in the range of 1:1000-1:1200. Just like happened to our surg. center administrator. (why do complications happen more to medical workers).

    The two most misunderstood numbers in medicine. 1) survival, and 2) relative change. ANY screen test for cancer, ANY test, assuming it is ever capable of cancer, will increase survival, even one does nothing with the result. This is because of how we define survival, the time one lives from the time of diagnosis. But I digress...

    Cancer screen is not cancer prevention.