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Last week I read the New York Times article “The $2.7 Trillion Medical Bill” by Elisabeth Rosenthal. The article started with the following chart.

Suffice it to say that anyone reading the above chart should be appalled. The chart above shows that Americans are paying much more for the same procedures, at times by several orders of magnitude higher. Sadly within the US, pricing from one hospital to the next can have even larger variations.

A Colonoscopy is a case in point. It is a perfect illustration of what is wrong with the American form of administering healthcare. First let me relay a short form of my personal story.

As a small business owner I purchased health insurance for the family after my wife stopped working. She stopped while pregnant with my 22 year old daughter. I have had continuous health insurance for the family for those 22 years through an engineer’s group plan. After the cost reached near $20,000 per year a few years back, I bailed into a catastrophic health plan for my daughter and me, and a high risk plan for my wife (she has Lupus and could not be insured otherwise). When my daughter started college, I added the college’s health insurance policy for my daughter. Yes, I have three policies.

In those 22 years I have never had a colonoscopy for screening. I knew it was time but since no one in my family that I knew had colon cancer, I figured it was a calculated risk. Because under the old health insurance paradigm, I knew if I had polyps, health insurance going forward could be rescinded or denied in the future. With the advent of Obamacare (Affordable Care Act), those fears were no longer there.

First, the cost of the colonoscopy was covered by my insurance policy, and no matter what was found, I would still maintain my policy and going forward I could still shop for any other policy like anyone else. Suffice it to say, two polyps were removed and it was the type that over the years could have turned cancerous. I think it is safe to say Obamacare saved me at least money and maybe my life.

Decisions like mine are made by millions of Americans every year because of a failed healthcare system. The major culprit is treating the entire healthcare system like a market where goods and services are traded and priced based on supply and demand. That has been one of the most immoral practices of our country. If one doubts this the following excerpt from the above mentioned article is probative.

Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased many fold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.

Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi-operation. They are often prescribed and performed more frequently than medical just guidelines recommend.

The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees. [source].

The same colonoscopy procedures can range from just over $1,000.00 to over $9,000.00 dollars. If you are self-employed with no insurance you pay the higher rate. If you have the muscle of an insurance group you may pay much less. If you have the muscle of ‘we the people’, your government, you would pay a price where theoretically gouging would not be allowed.

Markets are good in some areas and immoral in others. The identity of a nation should be defined by the education, upward mobility, and health of its citizens. The acceleration towards privatization is increasingly putting the vast majority of the nation on the losing side of all three. It is reflected in citizens’ aggregate education slippage relative to the rest of the world, diminished upward mobility, and aggregate poor healthcare outcomes.

Obamacare is a fair compromise in a misinformed country where socialized medicine is still a feared and bad word. A single payer system with cost controls is best. Notwithstanding all countries with better health outcome that follow that sensible model, Americans will eventually be forced to grow up. Americans will be forced to disregard the misinformation from the American Plutocracy that profits from their ignorance.



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Comment Preferences

  •  Transparency in medical costs is a good first step (2+ / 0-)
    Recommended by:
    bgblcklab1, thomask

    toward solving the problem.  Thanks for the diary.

  •  Five years ago I had two adenomas (1+ / 0-)
    Recommended by:
    thomask

    removed during a colonoscopy.  If I didn't have employer insurance I'd worry that I could get colon cancer.  It's in my immediate family and other relatives have also had this diagnosis.

  •  If everybody (3+ / 0-)
    Recommended by:
    thomask, NWTerriD, Willa Rogers

    had the pleasure of being self-insured for five years we'd have had single-payer a long time ago. The light bulb goes on fairly quickly after people who've never previously had the experience have to familiarize themselves with the process and personally deal with the insurance companies.  

    •  Or do without, as many have to do (1+ / 0-)
      Recommended by:
      corvo

      Because they can't pay the premiums.

      About half the states at the present time do not cover someone that is child-free, no matter how poor they are.

      Women create the entire labor force. ---------------------------------------------------------------------------------------- Sympathy is the strongest instinct in human nature. - Charles Darwin

      by splashy on Sun Jun 09, 2013 at 01:01:31 PM PDT

      [ Parent ]

      •  I know plenty of folks (1+ / 0-)
        Recommended by:
        Willa Rogers

        who can't help but afford their premiums -- it's automatically deducted from their paychecks -- but can't afford to use the insurance.

        Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

        by corvo on Sun Jun 09, 2013 at 02:13:16 PM PDT

        [ Parent ]

  •  Several orders of magnitude? (1+ / 0-)
    Recommended by:
    nextstep

    It's been a while since I was in math class but I don't see any examples in the chart shown in your diary where the US costs are several orders of magnitude higher the other country. In fact, only two examples appear to be one order of magnitude greater, but maybe in the material in the source document such examples are shown.  

    "let's talk about that"

    by VClib on Sun Jun 09, 2013 at 10:44:26 AM PDT

    •  Those of us who studied astronomy (3+ / 0-)
      Recommended by:
      BusyinCA, NWTerriD, wilderness voice

      know that the phrase "several orders of magnitude" was misused.

      Big fat hairy.

      In the real world, would you like to argue that the difference between a $35 angiogram and a $914 angiogram is trivial? to someone other than the One Percenters?

      Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

      by corvo on Sun Jun 09, 2013 at 11:40:44 AM PDT

      [ Parent ]

  •  A few quibbles (3+ / 0-)
    Recommended by:
    thomask, splashy, elmo

    First, it is unlikely that "If you are self-employed with no insurance you pay the higher rate." In my experience as a person without insurance, it is frequently possible to negotiate deals -- you may have to provide your tax returns or pay stub or whatever, but I've found hospitals and doctors will frequently cut a nominal bill by at least 50%, and/or offer a discount for paying it off at once (via credit card).

    But what is far more likely is that if you do not have insurance, you just do not do optional and very expensive services like colonoscopies. (The medical folks record this as "patient noncompliance" and scold you.) You put things off, especially things that are "just in case" when you have no symptoms. That's doubly true if you don't have any paid sick days from work, as the procedure requires you to take off a full day.

    Finally, the Times article also notes that outside the US, colonoscopies are not done nearly as often. Instead, doctors use much less invasive tests that are cheaper and easier, including blood in stool and sigmoidoscopies of only the lower region of the colon. And guess what? The statistics come out just about as good, at far lower cost.

    I've had 2 colonoscopies (when I had insurance), but I'm not at all sure I'll sign up for another one unless they can convince me there's some strong rationale for it.
     

  •  Well, not only that, but a couple years back (1+ / 0-)
    Recommended by:
    splashy

    Anthem/Blue Cross denied coverage of my 5-year colonoscopy on the grounds that anesthesia was administered.

    Took my doctor six months to fight them out of that one, not least because Blue Cross had preapproved the whole shebang.

    Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

    by corvo on Sun Jun 09, 2013 at 11:28:44 AM PDT

    •  Let's now count up the ways (0+ / 0-)

      in which the ACA keeps crap like this from happening again:

      1.

      Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

      by corvo on Sun Jun 09, 2013 at 12:34:09 PM PDT

      [ Parent ]

  •  alternatives (2+ / 0-)
    Recommended by:
    Papuska, elmo

    Up here is socialist Canuckistan in our area they have implemented routine sigmoidoscopies. I had one a couple of months ago. I also previously had a colonoscopy and I regularly do the fecal occult screening.

    Sigmoidoscopy an option for colon cancer screening

    The new findings provide more evidence that sigmoidoscopy as an initial test -- followed by colonoscopy only in the case of positive findings -- may be a valid alternative, researchers said.
    Here is the thing. Doctors make a fortune on colonoscopies by playing on the cancer fear. BUT !!! there are much cheaper alternatives that provide excellent results (except for the doctors'pocketbooks).

    I hated the colonoscopy. The sigmoidoscopy was not too bad at all, and the prep was a ton easier. But, here is the interesting thing. The sigmoidoscopy was done by 2 nurse practitioners and I was in and out in a hour. There has to be a HUGE savings there.

    But in a profit based medicine system don't expect to see that kind of change.

    There's room at the top they're telling you still But first you must learn how to smile as you kill If you want to be like the folks on the hill

    by taonow on Sun Jun 09, 2013 at 11:37:55 AM PDT

  •  I can not find a consensus 4 the >80 yr. old... (0+ / 0-)

    ...regarding whether Colonoscopy every three 2 five years, 4 the remainder of ones life is necessary.
    I intend to have a "FIT" test done in 2014 when, I'm told by a local surgeon that, in his practice I should have Colonoscopy repeated.
    If the Fecal ImmunoChemical Test is negative I will not repeat Colonoscopy yet again as long as the FIT continues negative at three to five year intervals or until a more accurate test is developed.

  •  Of course single-payer is best, (1+ / 0-)
    Recommended by:
    splashy

    and therefore America cannot have it.

    That's Republican thinking - anything good that happens would make the Democrats (as the governing party) look good, so nothing good can happen.

    "Violence never requires translation, but it often causes deafness." - Bareesh the Hutt.

    by Australian2 on Sun Jun 09, 2013 at 12:54:26 PM PDT

    •  It's the Democratic way of thinking too. (0+ / 0-)

      Remind me, will you, of how Barack Obama ensured that single-payer would be part of the negotiations on health insurance?

      Dogs from the street can have all the desirable qualities that one could want from pet dogs. Most adopted stray dogs are usually humble and exceptionally faithful to their owners as if they are grateful for this kindness. -- H.M. Bhumibol Adulyadej

      by corvo on Sun Jun 09, 2013 at 02:14:14 PM PDT

      [ Parent ]

  •  Promises promises (3+ / 0-)
    Recommended by:
    corvo, wilderness voice, chimene

    We were told we would get the same insurance as congress.  They have tried to stop their requirement to buy on the exchanges they have crippled.  They know why.  Close the special clinics in the Capitol building. Stop the "ex" military congresspeople from care usually given to the generals at military hospitals. Make them use the DC emergency rooms using non-VIP triage.  Result:  single payer system in one voice vote, no filibuster, no nonsense.  They have it all and then carp on us having even a bandaid.  Just ask Rand whose fortune comes from billing Medicare.

  •  I do have family history, I have discovered; had (0+ / 0-)

    my first quite late (62-ish) as part of the work-up to cancer surgery; and they found 3 polyps, 2 of which tested out as the type that allegely MAY progress to cancer.

    So that means I should have another in 3 years. Like, now. But I don't know if I can afford it again, the estimate last time was apparently for a procedure that only found NOTHING. My procedure found 3 somethings, and the price sky-rocketed.

    "real" work : a job where you wash your hands BEFORE you use the bathroom...

    by chimene on Mon Jun 10, 2013 at 12:50:43 AM PDT

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