Colonoscopies Are Over-Promoted, Over-Prescribed, and Over-Priced: Consumers Must Resist and Rebel

Introduction: some questions to set the stage

Should you trust your doctor? Is the medical system organized and controlled by the modern equivalent of highwaymen? What can we learn from the way colonoscopies are marketed and priced in the United States? What is the most important single lesson from a brief exploration of these questions?

Here are short answers to the first three of these rhetorical questions. I’m saving an answer to the last question (ie the recommended course of action) for last.

1. No, do not trust your doctor, if you are lucky enough to have immediate access to one or more doctors. Instead, be careful and double check, run independent checks on the relevant topics and get other qualified opinions. Doctors and other providers are not your enemies, but they are definitely not your friends either. They are highly trained professionals operating in a complex, profit-oriented, dysfunctional system. Most want to do the right thing, but the pressures exerted can lead even ethical professionals to justify that courses of action are not in your best interests. In this essay, I will argue that your interests and the public interest take a backseat to a kind of higher power: the profit motive.
2. Yes, the medical system is a 21st century highway robber.
3. Much can be learned from a close look at the colonoscopy industrial complex. The procedures that are performed can serve as canaries in the coal mine of the American medical system. Pay attention, be alarmed and do what you can to save yourself before it’s too late.

Colonoscopies, Medical Providers, and Free Enterprise Go Wild

Colonoscopies are the most expensive routine screening test in this country. A Commonwealth Fund report 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, Price, and Quality, May 3, 2012, Volume 10.) These figures are retail rates for the uninsured; insurers generally negotiate prices up to around $3,500. Americans lucky enough to have employer-sponsored insurance often assume that health care is basically free, despite rising copays and deductibles, but that’s not the case. Seniors with Medicare make the same mistake, often because they are exhausted (ie 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 average price of a colonoscopy is a few hundred dollars. Compare this with the US experience:

Americans pay more for almost all interactions with the medical system… A price list compiled by the International Federation of Health Plans found that medical services are more expensive in all categories, by a wide margin.

We lead the world in medical spending, yet numerous studies have shown that we do not receive better care and are less healthy than people in almost every other Western nation.

Forms of highway robbery in fourth-century America

In case you’ve been on the moon or out of touch for several years, here’s a summary of why so many experts believe the US health care system is out of control:

• Doctors prescribe expensive procedures. Yet the high price of ordinary accounts for our $2.7 trillion annual healthcare tab – 18% of GNP. ((Source: Elisabeth Rosenthal, Pay until it hurts: a case study in high costsNew York Times, June 1, 2013.)
• 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 reason for so many tests is defensive medicine. America is as litigious as it is religious. Physicians are bound (or pressured) by insurance regulations or their employers/professional societies/associations to avoid lawsuits, rather than impoverish the patient or even worsen their health.
• Pharmaceutical companies saturate the media with direct-to-consumer marketing. Drug saturation advertising campaigns for anything that does or could harm you distort patients’ judgments. Consumer appetite for quick fixes is nurtured. Patients are motivated to push providers for overpriced and overpriced products.
• Greed rules. So-called non-profit hospitals, insurance companies, device manufacturers, and other players in the medical industry are focused on making as much profit as they can legally justify. The pursuit of maximum returns is by far the number one goal in the American medical system.
• Drug-focused high-tech treatments predominate. A disproportionate amount of medical care and spending is devoted to chronic diseases in old age, leaving fewer resources for prevention, education, and acute care.
• Costs/benefits take a backseat. Substantial medical attention is washed into ministrations that simply prolong the dying process.
• There are very few incentives to act sensibly. Studies explaining the high costs and poor return on medical investment compared to other industrialized countries miss a disturbing reality: Americans are too fond of guns, gods, demigods, and drugs. They are far too uncommitted to reason and critical thinking, exercise, whole food plant-based eating, and the art of creating supportive environments for themselves and others.

Colonoscopies Como Coal Mine Canary Islands

Colonoscopy gets my vote for the biggest scam in modern medicine. We should stop using the term colonoscopy – colonoscamia it is much more descriptive and appropriate. The biggest scam distinction is no small honor or dubious distinction, given the abuses that could and have been documented about the US health care system. Colonoscopies are marketed using scare tactics, just like religions. The high chances of horrible torment and early death from colon cancer are sometimes described with almost perverse delight by colonoscopy counselors.

A year ago, I reluctantly agreed to sit in for a pep talk from a renowned proctologist. The topic was why should I have a colonoscopy, even though there are no risk factors other than old age. I agreed to the interview only after years of getting a colonoscopy harassed by friends, family, and various doctors, including even my dentist! Graphic descriptions of the dire consequences of missing a polyp would have done Hieronymus Bosch proud. I was reminded of the visions drawn by the nuns some 65 years ago at St. Barnabas Parish School. The eternal fires of hell were described in such fine and vivid detail that anyone would have been convinced that the nuns had been there. I think this whole scare was designed to ensure that I never missed Mass on Sundays. (For a while, I didn’t, although I did arrive as late as possible so my presence would still count.) So I listened to the colorful colonoscopy talk, and still decided against it. (I even wrote an essay about the interview experience.)

Colonoscopies are billed as quasi-operations. What was not long ago a simple office procedure has transformed into a more complex booming business. There are now surgery centers where lucrative colonoscopies are prescribed and performed above medical guidelines. The goal is to maximize revenue; lobbying, marketing and territorial disputes between specialists, in addition to huge profit margins, explain the high costs. Other tests for colon cancer are less invasive, cheaper, and just as effective.

Australia doesn’t even pay for colonoscopies as a standard screening procedure and it’s not common in other Western nations either.

The American Free Enterprise Anomaly

In this country, the government, unlike in any other industrialized nation, does not regulate or intervene in medical prices, other than setting payment rates for Medicare and Medicaid. Other nations view healthcare as a right for all and regulate hospitals and the rest of the service delivery system as public services. What conservatives like to call the free market is not so free for consumers.

Imagine if you went to a restaurant and ordered your food without knowing how much dinner would cost. Imagine the anxiety waiting for the waiter to arrive with the bill. Or apply the healthcare model to other regular purchases, large and small. What if the groceries you loaded up, brought home, and consumed from the grocery store were added up and posted to your account, but you didn’t see the bill for days or weeks, long after you’d processed most of what you took away? Such transactions are ridiculous, of course, and yet that’s the way it is in the medical system. Sometimes I get bills for medical procedures performed a year earlier, after the hospital or doctor has given up negotiations to get full or sufficient payment from the Medicare insurer.) It is strange, irrational, unfair and intolerable.

Summary and the Promised Takeaway Lesson

ask yourself, Should we be passive and tolerate this state of affairs? Consider that you don’t.

First, regarding colonoscopies, know that for most people, regular tests for blood in the stool are sufficient. Unfortunately for unsuspecting, easily intimidated patients, it’s hard to settle for this low-cost option. Such resistance to colonoscopies will be strongly resisted by the medical advisers involved in the procedure. Stool tests do not generate high revenue for this industry.

What can you do to avoid spending more on lower-quality health care while feeling worse and worse? You have three choices: die, move, or adopt a REAL wellness lifestyle. Stay with the latter until you move or die. I personally go with the REAL wellness lifestyle. Regarding the problem of colonoscopy, I prefer a whole plant based diet, lots of exercise and minor cancer detection methods over the unpleasant, expensive and questionable invasive procedure. Life is full of risk, and flesh is heir to more stones and arrows than expensive medical tests to detect and treat early on.

Going back to the three options (die, move, or adopt an RW lifestyle), I’m also sticking with the last one because the few countries I’d like to call home (Australia, New Zealand, Canada, and El Dorado) might not have me. But of course I’m really in favor of this choice because REAL wellness is a richer way of being alive. In my opinion, it’s the only way to fly, or to live, even if it didn’t save money and suffering in all sorts of chronic medical problems that I would surely have to endure if I were obese, sedentary, bored, or cranky, and I’m definitely not fat, sedentary, or bored.

Real wellness is what I suggest to take away from this cautionary tale about colonoscamia in America.