June 15--We pay more for our health care than any other nation in the world, get
less for our money and do not receive better services despite the cost.
That's the conclusion of a report by the Commonwealth Fund, a group that studies
health policy. The New York Times used the study to launch a series on health
care costs in the United States, beginning with an examination of colonoscopies.
Doctors routinely order the procedure to screen for cancer; as The Times
reported, it's the most expensive test that many healthy Americans undergo.
Patients in other countries typically pay a few hundred dollars for a
colonoscopy, usually far less than $1,000. In the United States, the average
cost is $1,185, and it varies wildly depending on location and provider, with
some bills hitting more than $8,500.
In fact, The Times reported, the procedure -- like many other routine health
tests -- costs more in the United States than anywhere else in the world. And
patients don't know what they will wind up paying until they get the bill.
It's enough to make you sick. It's also enough to make a diagnosis: Until the
United States finds a way to make health care prices transparent, to give
consumers real ability to comparison shop and to truly control costs through
market forces, those costs will continue to climb to nauseating heights.
The Times chronicled a dizzying array of factors that affect health care prices
in the U.S. The price tag jumps thousands of dollars for a colonoscopy performed
in an outpatient surgery center rather than a doctor's office. It might be
performed at the center not because it's safer, or better, or easier, but
because it's more convenient for the doctor's schedule -- and earns the
physician extra payment in the form of "facility fees."
Other methods of screening for colon cancer are cheaper and just as effective,
The Times reported. But colonoscopy has become the screen most recommended by
doctors. It's also the most expensive.
That might not be a coincidence.
The Commonwealth Fund study systematically dismantled many of the rationales
often cited for higher health care costs in the U.S. as compared to other
industrialized countries. We have high obesity rates, but we also have fewer
smokers. We have plenty of aging Baby Boomers, but other industrialized nations
have older average populations than the U.S. We have fewer doctors and hospital
beds per capita, and we see doctors at a lower rate than the other countries in
We pay more because our prices are higher, the study concluded. And our prices
are higher, The Times reported, because we have no ability to comparison shop,
as we might do for any other good or service.
Even the doctors providing the care often don't know what it costs, because the
price does not rely on the usual measures such as equipment, resources or time
needed to provide the service. Instead, the price varies depending on who you
are, where you are, if you have insurance, which insurance it is or, heaven help
you, if you have no insurance at all.
None of the usual forces that shape other markets -- supply and demand,
economics of scale, competition -- apply to health care prices because consumers
need a cryptographer and a guardian angel to determine what any procedure should
Informed consumers can make good decisions. Without them, an entire industry
exhibits symptoms of distress.
(c)2013 The Virginian-Pilot (Norfolk, Va.)
Visit The Virginian-Pilot (Norfolk, Va.) at pilotonline.com
Distributed by MCT Information Services