$3,500 is the amount US insurance companies pay for a screening colonoscopy that takes 30 minutes. In some states a $9,000 charge is routine. In the country of Switzerland the cost is $655 using the same techniques and the same scope from Japan. This sad story of price gouging was reported in detail by the New York Times on Sunday June 2, 2013.
Key points about high charges from the Times’ article include:
- Adding charges for an unnecessary anesthesiologist
- Adding facility fees by calling colonoscopy a surgery
- Adding huge fees for biopsies that take only minutes
- Repeating colonoscopy too frequently
If it was just colonoscopy that was the cause of the problems with high cost in the US it would be an easy fix. But, the pattern of prices having no basis in actual cost is a systemic problem of huge proportions.
In other walks of life people would not tolerate the abuse. We would complain bitterly if a garage mechanic charged for someone to hold his light, or added a fee to use the garage space, or tacked on a charge to check tire pressure or wanted to recheck the muffler every 3 months.
Why do people tolerate unreasonably high medical prices? Because people do not understand health care. Because insurance shields them from the need to understand. And, because we think 10 years of training is needed to do many procedures, which is absolutely not true.
Surgeons and gastroenterologists study many things but if colonoscopy was separated out, the total training time for that procedure itself is probably only a few months. A trained physician assistant or nurse practitioner could easily do a screening colonoscopy at much lower cost and with equal safety. The manpower drain from gastroenterology to do screening colonoscopy is astounding and the only reason they do it is the high reimbursement.
Keep in mind, it is not people causing the problem. The fault is with the warped system of care and reimbursement we have devised.
To fix the problem the US system of payment must change to be more like other advanced countries. That means either the prices for procedures are set nationally (the French way) or large conglomerates of doctors and hospitals are paid to provide all necessary care to people on a per capita basis (the ACO way).
Numerous publications are reporting on the problems in our health care system. The New York Times, The Wall Street Journal and Time Magazine have had lead articles on the subject.
The problem of high cost will need government action to make a significant change since no business is large enough to force the issue alone. It is easy to be pessimistic — but, there is a tipping point coming. When consumers realize lower-cost higher-quality health care is possible they will want it.