Introduction: Four Questions
Should you trust your doctor? Is the medical system organized and controlled by the modern equivalent of highway robbers? What can we learn from the way colonoscopies are promoted and priced in America? What is the single most important takeaway lesson from a brief exploration of these questions?
Here are short answers to the first three of these rhetorical queries. I'm saving a response to the last question (i.e., recommended course of action) until the end.
- No, don't trust your doctor, if you are fortunate enough to have ready access to one or more medical practitioners. Instead, be wary and verify, do independent checks on the pertinent issues and obtain other qualified opinions. Doctors and other provider are not your enemies but they're definitely not your friends, either. They are highly trained professionals who function in a complex dysfunctional system oriented to profit. Most want to do the right thing but pressures brought to bear can lead even ethical practitioners to justify action courses not be in your best interest. In this essay, I'll make the case that your interests and the public interest take a back seat to a higher power of sorts - the profit motive.
- Yes, the medical system is highway robbery, circa 21st century.
- Plenty can be learned from a close look at the colonoscopy industrial complex. The procedures being performed can serve as canaries in the American medical system coal mine. Pay attention, be alarmed and do what you can to save yourself before it's too late.
Colonoscopies are the most expensive routine screening test in this country. A report by the Commonwealth Fund revealed that this procedure is billed at rates ranging from $6,385 to $19,438. (See Explaining High Health Care
Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, May 3, 2012, Volume 10.) These figures are retail rates for the uninsured; insurers usually negotiate prices down to about $3,500. Americans fortunate enough to have employer-based insurance often assume that medical care is basically free, despite rising co-payments and deductibles, but it's not. Seniors on Medicare make the same mistake, often because they are exhaustipated (i.e., too tired to give a shit).
Like the high costs of our wars in Iraq and Afghanistan, everyone pays in the end, no pun intended.
In other Western countries, the price tag for a colonoscopy averages out at a few hundred dollars. Contrast this with the U.S. experience:
Americans pay more for almost every interaction with the medical system...A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories - and often by a huge margin." (Source: Elisabeth Rosenthal, “Paying Till It Hurts,” New York Times, June 1, 2013.)
We lead the world in medical spending, though numerous studies have shown we do not receive better care and we are less healthy than people in nearly every other Western nation.
Forms of Highway Robbery in America's 4th Century
In case you have been on the moon or otherwise out of touch for several years, here's a summary of why so many experts believe the U.S. medical care system is out of control:
- Doctors prescribe expensive procedures. However, the high price tag of ordinary ones (quote from the Times report cited above) accounts for our $2.7 trillion annual medical care tab - 18% of GNP.
- Doctors promote too many tests. According to the CDC, more than ten million Americans each year undergo colonoscopies (at a cost of $10 billion annually). One motive for so much testing is defensive testing. America is as litigious as it is religious, noted Iris Vander Pluym, AWR adviser and Matriarch of the Perry Street Palace (in private correspondence). Doctors are required (or pressured) by insurance regulations or their employers/partnerships/professional associations to prevent lawsuits, rather than to patient impoverishment or even bad health outcomes: I ordered a colonoscopy for this patient at age 50, therefore I cannot possibly be liable for his advanced colon cancer that turned up two years later.
- Pharmaceutical companies saturate the media with direct-to-consumer merchandizing. The saturation ad campaigns for drugs for whatever does or could ail you distorts patient judgements. Consumer appetites for quick fixes are encouraged. Patients are motivated to pressure providers for overpriced, overrated products.
- Greed rules. So-called non-profit hospitals, insurance companies, device makers and other players in the medical industry are focused on generating the highest possible profits they can legally justify. The quest for maximum returns is by far the number one objective in the American medical system.
- High tech, drug-focused treatments dominate. A disproportionate amount of medical care and expense is lavished on chronic conditions in later life, leaving fewer resources for prevention, education and acute care.
- Cost/benefits take a back seat. Substantial medical care is lavished on ministrations that simply extend the dying process.
- There are too few incentives to act sensibly. Overlooked in studies to explain the high costs and poor return on medical investments relative to other industrialized countries is a disturbing reality: Americans are overly fond of guns, gods, demigods and drugs. They are too little committed to reason and critical thinking, exercise, whole food plant-based dining and the art of shaping supportive environments for themselves and others.
The colonoscopy gets my vote as the biggest scam in modern medicine. We should stop using the term colonoscopy - colonoscamy is much more descriptive and appropriate. Given the abuses and waste well documented about the U.S. health care system, this is a searing indictment. Colonoscopies are marketed by fear tactics, not unlike religions. The high possibilities of horrific torment and premature death from colon cancer are sometimes described with almost wicked delight by colonoscopy counselors.
A year ago, I reluctantly agreed to sit for a pep talk by a renowned proctologist. The topic was why I should have a colonoscopy, despite no risk factors save old age. I consented to the interview only after years of get a colonoscopy badgering by friends, family members and varied medical practitioners, including even my dentist! The graphic descriptions of dire consequences of failing to detect a polyp would have done Hieronymus Bosch proud. I was reminded of the visions drawn by nuns 65 years or so ago at St. Barnabas Parochial School. The eternal hell-fires were described in such fine and vivid detail anyone would have been convinced the nuns had been there. I think all this fright was designed to insure that I never missed a mass on Sundays. (For a while, I didn't, though I did arrive as late as possible so that my being there still counted.) So I listened to the colorful colonoscopy pitch - and still decided not to do it.
Colonoscopies are billed as quasi operations. What a short time ago was a simple office procedure has morphed into a more complex booming business. Now there are surgery centers where lucrative colonoscopies are prescribed and performed in excess of medical guidelines. The goal is to maximize revenue; lobbying, marketing and turf battles among specialists, plus huge profit margins, account for the high costs. Other tests for colon cancer are far less invasive, cheaper and equally effective, according to a federal
expert panel on preventive care.
Australia does not even pay for colonoscopies as a standard screening procedure and it is not common in other western nations, either. Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is quoted in the Times story cited above, as follows: We've defaulted to by far the most expensive option, without much if any data to support it.The American Free Enterprise Anomaly
In this country, the government, unlike in any other industrialized nation, does not regulate or otherwise intervene in medical pricing, other than setting payment rates for Medicare and Medicaid. Other nations view health care as a right for all and regulate hospitals and the rest of the delivery system as public utilities. What conservatives like to call a free market is not so free for consumers. Again, citing the Times report: Patients do not see prices until after a service is provided...there is little quality data on hospitals and doctors to help determine good value...and even doctors often do not know the costs of the tests and procedures they prescribe.
Imagine if you went to a restaurant and ordered your meal with no clue what the dinner would cost. Imagine the anxiety waiting for the waiter to arrive with the check. Or, apply the medical care model to other normal purchases, large and small. What if the supermarket groceries you loaded up, took home and consumed were added up and recorded in your account, but you did not see the bill for days or weeks, well after you processed most of what you carried off! Such transactions are ridiculous, of course and yet that's how it is in the medical system. I sometimes receive bills for medical procedures rendered a year earlier, after the hospital or medical practitioner has given up on negotiations for full or good enough payment from the Medicare insurer). It's bizarre, irrational, unfair and intolerable.
Summary and the Promised Takeaway Lesson
For starters, read the New York Times story about paying till it hurts entitled, Colonoscopies Explain Why U.S. Leads the World in Health Expenditures. It's five times more detailed than this overview and loaded with references and examples.
Then ask yourself, Do you have to be passive and tolerate this state of things? Consider that you do not.
First, with regard to colonoscopies, know that for most people, regular testing for blood in the stool is sufficient. Unfortunately for unwary, easily intimidated patients, settling for this low cost option is difficult. Such resistance to colonoscopies will be mightily resisted by medical counselors involved with the procedure. Stool testing is not a high revenue producer for this industry. Consider this, also from the Times report: Studies have not clearly shown that a colonoscopy prevents colon cancer or death better than the other screening methods. Indeed, some recent papers suggest that it does not, in part because early lesions may be hard to see in some parts of the colon.
What can you do to avoid spending more for lower quality medical care while becoming less and less well? You have three options: Die, move or adopt a REAL wellness lifestyle. Stick with the latter until you do move or die. Personally, I'm going with the REAL wellness lifestyle. With regard to the colonoscopy issue, I favor a whole food plant based diet, plenty of exercise and lesser methods of cancer detection over the unpleasant, costly and dubious invasive procedure. Life is full of risks - and the flesh is heir to more slings and arrows than there will ever be costly medical tests to detect and treat early on.
Getting back to the three options (die, move or adopt a RW lifestyle), I go with the latter as well because the few countries I'd want to call home (Australia, New Zealand, Canada and El Dorado) might not have me. But of course I really and truly favor this choice because REAL wellness is a richer way to be alive. It's the only way to fly, or live, in my opinion, even if it did not save money and grief on all kinds of chronic medical problems I'd surely have to endure if I were obese, sedentary, bored or ornery - and I'm definitely not fat, sedentary or bored.
My suggested two-part takeaway lessons based on the realities described in this essay about the colonoscamy scandal in America are:
- Adopt a default position on this and all other medical screenings, tests and procedures - skip them unless different medical experts are able to convince you that your unique situation and the absence of good alternatives warrant a screening, test or procedure. In that case, be sure you pursue some sound estimates of the costs; and
- Mitigate your exposure to the medical system by pursuing and always fine=tuning a first-rate REAL wellness lifestyle.
Lots of luck - given the U.S. medical system, we’re all going to need it.