Colonoscopies explain why US leads world in health care expenses

UPDATE: There are an amazing number of personal stories with dollar-data in the comments. Please check them out. And thanks to all the commenters for sharing this information.
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Another Quick Hits (a click-and-read), this time on the high cost of U.S. health care. This article in the New York Times explains the situation perfectly. The seed for the story is the price of a colonoscopy. Note first the variation in U.S. prices, then the prices in Europe and other (more) developed countries.

Elisabeth Rosenthal starts her story this way (my emphasis):

The $2.7 Trillion Medical Bill

Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.

“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.

The story is an eye-opener. There are a plenty of perps, including employer-provided health care and its built-in problems.

The article says this about the reasons for the high costs:

The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.

Please do click; please do read. It’s worth your time. The article is both stark and clear. When you have this conversation with your neighbors, you’ll be well armed.

Oh, and there’s this handy chart — perfect for taping to the refrigerator door.

Source: 2012 Comparative Price Report by the International Federation of Health Plans. The average prices shown for colonoscopies do not include added fees for sedation by an anesthesiologist, a practice common in the United States, but unusual in the rest of the world. The additional charges can increase the cost significantly.

Source: 2012 Comparative Price Report by the International Federation of Health Plans. The average prices shown for colonoscopies do not include added fees for sedation by an anesthesiologist, a practice common in the United States, but unusual in the rest of the world.
The additional charges can increase the cost significantly.

As John has pointed out many times, it’s often cheaper to pay cash in Europe than to pay U.S. prices, even with “insurance.”

GP

To follow or send links: @Gaius_Publius


Gaius Publius is a professional writer living on the West Coast of the United States. Click here for more. Follow him on Twitter @Gaius_Publius and Facebook.

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  • mark_in_toronto

    My recent colonoscopy here was totally free.
    8 years ago in the US, it was over $5000.

  • http://poodyheads.wordpress.com/ Papa Bear

    Hopefully, that will happen for all of us, in spite of the cultural wars our “free” country’s going through…

  • http://adgitadiaries.com/ karmanot

    Same with me.

  • Naja pallida

    I’ve read multiple studies which show no effects on glucose metabolism, which was a concern to me… but I can only really judge by my own personal experience, and since I can walk without pain for the first time in years, and no notable irregularities in my blood tests, I’m gonna stick with it. :)

  • Naja pallida

    Actual out of pocket cost is always going to be higher for the uninsured, but the actual “list price” is generally much lower. They bill the insurance company $3000, you probably only pay $1000 if you had insurance. But without insurance, they bill you $1500.

  • Sweetie

    Glucosamine is worse than a waste of money. It only does one thing: worsen the body’s handling of glucose.

  • Sweetie

    I’ve heard the opposite: that procedures for the uninsured tend to be higher.

  • http://adgitadiaries.com/ karmanot

    I just want someone dear to hold me when the end comes.

  • Mary O’Grady

    With junk insurance, the colonoscopy of my partner, who had symptoms and *really* had to have the colonoscopy right away, cost us nearly $4000. (Thankfully, it was a false alarm.)
    Since that incident, years back, the junk insurance company has been forced by the Affordable Care Act to send us a couple of nice checks for gouging us for years.

  • Naja pallida

    One possible reason for better outcomes in cancer treatment is that American doctors may be more willing to go straight to the most expensive and/or more radical treatments, where in nations with publicly funded health care, they tend to take a more conservative step by step approach, in an effort to be more cost effective. Which, specifically in the case of cancer, can be the poorer choice for a course of treatment. As cancer generally only gets harder and harder (and thus more and more expensive) to treat, the longer you leave it. So if the first thing you try isn’t effective, the next step is only going to be that much more difficult.

    Of course, the better outcomes still only apply to people who can afford treatment.

  • DGT

    I had the same issue when I had shoulder surgery. One of them (I don’t even remember what is was for) was a bill for around $2 that my insurance didn’t cover. I didn’t really pay much attention to it, but they kept billing me and eventually turned me over to a collection agency. So I finally sent the collection agency a check for $2 using the business reply mail envelope they sent.

    I don’t know how much they spent in postage to collect that $2.

  • Naja pallida

    I know how that goes. My dog also has a cyst that I was quoted at $500 – starting cost, barring any complication – to remove. It’s not impairing her in any way, other than being rather ugly. So my vet and I have decided just to leave it be, unless it gets to the point we need to do something. It is sad to enough to have to make the choice to put off medical procedures for pets, but whenever I consider that there are human beings who have no choice but to do the same thing with their own health. Putting off getting treatment, because they can’t afford it, until they have no other choice. When almost all conditions are cheaper and more readily treated the earlier you start. It just makes me angry. This is not how things should be. Having a pet is an expense we choose to take upon ourselves. Simply wanting to live is not.

  • http://adgitadiaries.com/ karmanot

    LOL!

  • http://adgitadiaries.com/ karmanot

    It would help to have extra stomachs like cows so we could chew cud all day and be outstanding in our dietary pastures.

  • http://adgitadiaries.com/ karmanot

    In documentaries in secret rooms of the archives of The National Geographic stored in the Library of Congress.

  • http://adgitadiaries.com/ karmanot

    Yep, our old Cocker is very high maintenance these days, but deserves all our love including financial sacrifice for his long years of loyalty and evotion.

  • http://adgitadiaries.com/ karmanot

    You are so right about Costco prices.

  • http://adgitadiaries.com/ karmanot

    Same!

  • http://adgitadiaries.com/ karmanot

    That’s what I had to do…..it’s one of the first procedures guaranteed by Medicare.

  • http://musephotos.wordpress.com/ GarySFBCN

    I occasionally need to use a prescription medication. In the US, my insurance co-pay for the drug is $25 and the rest is paid by the insurance company, which is $83. In Spain, buying the same medication at the pharmacy, and not using my Spanish medical insurance card, cost me $5.16 (3.14 in euros). Same medication – packaging and all. Somebody is making a buck.

    Interesting that Gaius selected a cancer screening to launch into this essay. When compared to the rest of the modernized nations, the US spends more on healthcare. And we have worse outcomes except for treating cancer. For some reason, we do better with cancer than most other nations. I don’t know why.

  • nicho

    Where are all these 150-year-old vegetarians and vegans?

  • Indigo

    I’m in a similar situation as far as family history is concerned. Medicare covers the entire procedure for me but even then, I find the local medical doctors I go to have brought it in for less than $1,000. I make a point to ask my regular physician to prescribe low cost procedures and, somehow, she manages to respect that. In my opinion, it’s important to understand that “most expensive” does not mean “best care” and to say so loudly in the doctor’s office. Since I’m already an old guy, I get away with that. :-)

  • Naja pallida

    At my local gastroenterologist, if you tell them up front that you don’t have insurance, they knock 50% off the cost, immediately. That makes it pretty clear to me that the price is at least twice as expensive as it should be, but ultimately what it says is that it is insurance companies that set the rates. Not providers. Doctors offices are happy to charge insurance companies whatever they think they will be able to milk out of them… and if they know the insurance company will happily pay 3000 for a 1500 dollar procedure, why would they ever intentionally reduce the price they charge them? It is entirely on the insurance industry to bring costs down. But what incentive do they have to bother, when there is so much money to be made by bankrupting people for every illness?

  • mirror

    My 13 yo cat has non-infected cyst that we have just been periodically draining for about a year and a half or more. Doesn’t seem to bother her. We just don’t have $400 for the procedure. Its enough just doing the routine stuff.

  • Asterix

    My physician reminded me recently that I was overdue for a colonoscopy (my father and his brother both died of lower bowel cancer, so I’m viewed as a good candidate). I consulted my insurance company to see how much of a “routine” exam they would cover. What they said shocked me.

    First of all, they don’t classify it as an exam. Since it involves administration of a sedative, they classify it as a surgical procedure. Since it isn’t strictly a matter of alleviating a symptom or an illness, it’s also an “elective” surgical procedure. Since the practice that performs colonoscopies in this area was removed from their approved providers list a year ago, they classify the procedure as “out of system”.

    I can’t afford what that leaves me to pay. I’ll wait to see if Medicare will cover it in a year or so when I’m eligible.

  • Indigo

    You’re mistaken. Frances Farmer Canine, my rescued Australian Cattle dog, during her last weeks with guarded palliative care, euthanasia and cremation costs ran me over $5,000 that I didn’t really have and am still paying off on the credit card two years later. I can’t afford the costs associated with getting a new rescue dog.

  • Monoceros Forth

    And to think that if people ate the plant-based, whole foods diet to which humans are naturally adapted…
    Hahaha

  • Monoceros Forth

    It just reinforces my conviction that the people who bitch the loudest about the evils of gummint-regulated health care and who make the most outlandish claims about it simply have no actual experience with it–and don’t care to find out the truth from people who have, either.

  • Naja pallida

    Eat that much fiber, and you’ll be farting everywhere. :)

  • Naja pallida

    The number one reason why pet health care is generally cheaper is because insurance companies are not involved. Every single procedure, medication, practitioner, is highly regulated by government.

    But if you want to compare procedures, I deal with vet costs all the time. I got an abdominal ultrasound for my dog a few weeks ago, and it cost ~$300. I had one myself last year, before insurance, it cost about ~$400. Teeth cleaning? Me, $60. Dog >$500, because it is a more involved procedure. For those medications which also have a human use, the prices are pretty much identical – often they’ll even send you to a regular pharmacy to fulfill the prescription, because a place like Walgreens or Costco pharmacy can generally get it cheaper because of volume purchasing, than a vet’s office can. Supplements… hard to judge, they vary by brand, but glucosamine supplements, which both my dog and I take, we both pay about the same per month.

    This argument is ridiculous, and simply not applicable to the problems we have with human health care.

  • http://poodyheads.wordpress.com/ Papa Bear

    Not quite — the guardians of the pets are given a choice…

  • http://adgitadiaries.com/ karmanot

    Drives me crazy too! Especially those $20.00 cue tips and $50.00 gift bags with a tiny tube of toothpaste and micro toothbrush made in slave labor China.

  • http://adgitadiaries.com/ karmanot

    Oh please, you bring a rabbit based diet to this discussion. That’s like farting in church.

  • http://adgitadiaries.com/ karmanot

    That sounds about right. Two years ago I became ‘suddenly’ ill, had four emergency room visits. I had been healthy all my life—didn’t even have a doctor and no insurance.The cost was over $8000.00 ( a hospital cut rate) and destroyed my life savings.

  • http://adgitadiaries.com/ karmanot

    “Health care for pets is cheaper” In America, that relatively so statement still makes vet care virtually beyond the capability of millions to pay.

  • http://adgitadiaries.com/ karmanot

    Yep, that’s our experience. It’s particularly traumatic for low income seniors, who can barely afford their own health care, to watch their longtime pet companions suffer because the expense is simply to great to meet and then ‘put down’ a beloved family member. We seriously regret that we didn’t emigrate to Ireland when we had the chance and leave this god forsaken country in the dust. At our age and condition we will be treated just like our pets in time. Thanks Obama.

  • http://adgitadiaries.com/ karmanot

    I wish that were true. Here in CA, vets have become boutique outfits. A polyp removal for our little Cocker cost $600.00. We had to save for several months to cover it and by then it had gotten much worse.

  • http://adgitadiaries.com/ karmanot

    I wish that were true. Here in CA, vets have become boutique outfits. A polyp removal for our little Cocker cost $600.00. We had to save for several months to cover it and by then it had gotten much worse.

  • Monoceros Forth

    I’ve seen this bizarre talking point before. It’s really weird when you think about it. What sort of comparison is there between the relatively simple practice of veterinary medicine and the costly requirements of human healthcare? Consider this also: any really difficult treatment for animals simply isn’t done at all because it’s decided that it’s easier to pump the suffering animal full of Nembutal and end it all. I’m assuming you’d prefer human health care to adopt the same method to cut costs?
    It’s a lie anyway. Just look up the costs of major surgery on animals. It’s no cheaper than the equivalent surgeries on people.

  • cole3244

    single payer please.

  • cole3244

    single payer please.

  • AttilatheBlond

    Health care for pets is cheaper, lot less middle men corporations involved. If pet health insurance becomes a big thing, look for pet healthcare costs to rise too.

  • http://www.rebeccamorn.com/mind BeccaM

    I’ll trot out my usual example: My wife suffered a torn retina while we were in India. After a local optometrist diagnosed it, we hired a car to take us to Bangalore where we went to one of their newest “super-specialty” hospitals. Everything bright and shiny, and with specialists in just about every discipline of importance.

    After filling out just a couple of forms and paying an initial admitting fee (cash), we were assigned a kind of “hospital concierge” — a woman who took care of us and saw us up to the specialist’s office, answering all our questions and even giving us her business card if we ran into any trouble.

    Anyway, long story short, the initial specialist consultation, the laser surgery to reattach the retina, a few post-procedure prescriptions, and two follow-up visits 2 and 4 weeks later were all covered by a single charge. Which converting from Rupees to U.S. dollars at the exchange rate at the time was about $39.

    When we got back to the States, my wife’s cousin who is also an eye doctor took a look at the work and pronounced it every bit as good as anyone could’ve expected here. And he said that the procedure would’ve cost a minimum of $3,000, more likely $5-6,000.

    He also said my wife’s cataract surgery was very well done, too — we decided to take care of that over there as well. And at a cost 1/5th to 1/10th what it would’ve been here.

  • http://parkandbark.wordpress.com/ Houndentenor

    1. My “free” physical last year cost over $100. That’s not a huge amount of money but it sure as hell wasn’t free. There was a time when it was illegal to flat out lie to customers. I guess those days are gone.

    2. The reason these tests are cheaper in most countries is that they have single-payer health care. It’s in the interest of the health care system to catch a problem earlier rather than later. It costs a lot less to treat and of course it’s better for the patient as well since the results are likely to be better as well. Insurance companies don’t really want to do all these tests because you might well change jobs and insurers next year and whatever problem isn’t found now will be someone else’s expense.

    3. Note that the insurance company got the bill cut in half. A person paying out of pocket wouldn’t be able to do that and would get priced gouged for the extra $3000+.

    4. Note that you can’t get a straight answer out of any health care provider about price before the procedure is completed. So much for price comparisons. If they can tell you it’s free and then hit you with a bill for over $6k, this is obviously not the typical consumer-driven supply and demand market.

  • guest1

    Healthcare for pets is way cheaper, lot less government involved

  • http://www.postlinearity.com gregorylent

    no accountability … “insurance will pay for it” … and greed

  • Tony T

    I just had my first. I don’t have insurance so I shopped around. I choose a local hospital because they offer financial assitance for certain wage levels. The Dr. was $350. I could have used his outpatient facility for $1600 but gambled on zero with financial assitance from the hospital. They sent me the bill $6,000 (after 40% for no insurance) plus $1200 for the anesthetist. I rolled the dice and am waiting to see how much they will write off. Also, people should check out http://www.colonoscopyassit.com They have negotiated a flat fee of $900 all across the country. Don’t know how readily available they are as there was only one location in all of Chicagoland.

  • Lthomas320

    And to think that if people ate the plant-based, whole foods diet to which humans are naturally adapted, things like colonoscopies would barely be on anyone’s radar, because the risk/incidence of polyps/cancer would be so low. That’s how you reduce health care costs.

  • ab

    The thing that drives me bonkers (in addition to the costs) is that I get four or five bills for the same procedure — the anesthesiologist, the guy who performs a procedure (usually a guy), the cost for any meds used, and the test done on anything removed. They trickle in for a month or two after the procedure, and when I think it is done, there is another one! I am paying for all the office staff to bill me for these as well. Efficiency is not greater with private industry, no matter how loudly you yell.

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