Tuesday, March 27, 2018

It is the damn price, stupid!

For a couple of years, my primary care physician has talked to me about colonoscopy.  A well-accepted preventive care routine, he has assured me.  And, yes, when doing that, they will also check the state of my prostate.  And, yes, the insurance will pay for most of the expenses too.

"Let me think about it," is my typical response to him.  I have been putting this off for a while now.

If I were to pay out of my pocket, I would not undergo this. 

Given my dietary habits, the type-4 "regularity," if you get my drift, and a near-maniacal approach to a healthy living means that it is an ultra-low probability of something wrong in the colon.

In addition to the discomfort with the process, it is also insanely expensive--if I were to pay for it.  The cost of colonoscopies is typical of the most important problem in healthcare in the US: The astronomical prices:
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 manyfold 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.
...
While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care — and are commonly used in other countries — colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. 
If I were to pay for the colonoscopy, I would think about the benefit from such an expense.  For now, it is clear--way expensive and not worth it, irrespective of the fact that the insurance company picks up the tab.

Colonoscopy is merely an example of the pricing aspect of the healthcare crisis.  All Obamacare, which trump and the Republicans failed to repeal-and-replace, does is to make that healthcare affordable; there is nothing being done- to bring down the prices.
The Affordable Care Act did many things. It extended coverage to millions of Americans and created a more equitable health insurance market that treated healthy and sick patients equally.
But that law did not tackle the unit price of health care in the United States.
“The ACA didn’t change the trajectory at all,” Hopkins’ Anderson put it bluntly.
The ACA made health care more affordable in the sense that more Americans have someone else (Medicaid or a private insurance company) paying the majority of those medical bills.
But the medical bills themselves didn’t actually shrink — and that will vex any effort at reducing the cost of American health care going forward.
Ah, but do not ever reflexively think this is the market at work:
“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”                                         
We are screwed!