While reading the New York Times (NYT) this past Sunday (What?  You don’t?), I was struck once again how the law of unintended circumstances comes into play.  [Ed:  This was written 3 June 2012.]  The Times’ front page article headline read:  “The $2.7 Trillion Medical Bill”, which really focused on just one medical procedure- colonoscopic exams.

It seems that the prices for this procedure comes in on the order of $ 3,000 to $ 9,000 here in the US.  Yet, that same procedure in other “developed countries”  (that’s how the NYT described the “first world countries”) comes in under $ 1000.  Yes.  That’s right- we are paying 3X to 9X the “going” rate for this procedure.   And, the NYT claimed this is one of the reasons why our health care costs keep us in the stratosphere.  Even though patient health is not.

It turns out that folks in the US have the most costly procedures for 21 categories (as determined by the International Federation of Health Plans; no longer available on the IFHP website).  And, that makes no difference whether we compares our fees and costs to those covered by a national health care plan or those covered by private insurance in other countries.

It turns out that a colonoscopy is the most expensive screening test that exists in America.  And, the numbers they are prescribed have exploded over the past 15 years, with some 10 million procedures a year effected, with an annual cost of $ 10 billion.  Part of that reason is that physicians (and a few entrepreneurs) found out that they could run a “surgical center” to merit these high fees, billing them as “quasi-operations”, complete with anesthesiologists.

Apart from Medicare and Medicaid (health care for the aged and the poor, respectively), the US Government does not set ceilings- or even suggested rates- for medical procedures or drugs.  And, the second I bring this up (or, even if anyone else does, for that matter), there is an immediate squeal of socialized medicine or government intervention in private enterprise.   Yet, we, as a country, are going to go broke if we don’t break this vicious cycle- because some 18% of our GDP is wound up in healthcare- thereby squeezing out funds for every other need that exists.

But, healthcare is NOT a free market.  The consumer- that’s you and me, folks- has no idea what the costs are going to be for any procedure.  We only find out AFTER our insurance company processes the bill and then lets us know how much we owe.  Consider buying a car- and not knowing what your monthly (or total costs) will be- until after you’ve driven it 1000 miles and are then stuck with the tab.  And, if you have no insurance coverage, then the list price is what you will pay- because there is no one in your corner telling the practitioner (and/or hospital) that there is no justification for that list price.  Nor do you have any control choosing the “best” practitioners- since that sort of  data is never (ok, once in a blue moon) reported.

Going back to colonoscopies, we all agree that colon cancer screening is a critical health procedure.  But, that does not correlate with mass prescriptions for colonoscopy.  Except that the American College of Gastroenterology published their preference that colonoscopy was the preferred diagnostic procedure.  And, of course, who performs these operations?  Gastroenterologists.

Now, back to the unintended circumstances.  Back in the mid-80’s, the colonoscopy exams  were just coming to the fore.  And, they did cut down on extensive hospital stays.  And, this trend became possible, because a colon electrolyte lavage solution was developed to insure that bowel surgery did not kill off almost ½ of the patients who underwent that procedure.  Without a thought of colonoscopy. This lavage was an uncomfortable 3 or 4 hour process, but one that was far more effective at cleaning out the entire colon than an enema could ever hope.  This lavage removes bacteria, debris, and food particles, leaving a virtually pristine colon, at a delivered cost of $ 25 or less.  And, while it was developed to make bowel surgery safe, it was now available to prep for colonoscopy, making that $ 10 billion “industry”  possible.

Now, this procedure is omnipresent.  Because those that provide it in their own surgical centers know that profits for each investor is on the order of $ 1 million a year- and the vendors’ promotional materials prove that it offers a 100% return on investment- within 15 to 19 months.   So, it’s not surprising that gastroenterologists perform more ambulatory (out-patient) surgeries than any other specialty in the US, and are among the top grossing of all medical specialties.

Just imagine if we could have made that lavage taste just a little better…. But our goal was surgical prep and keeping patients alive and healthy, not colonoscopic exams.

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