The New York Times had a front page article today on the high cost of colonoscopies. The article which spanned two full pages inside the A section bemoans the fact that people undergo colonoscopies when there are less expensive procedures readily available. That train however has left the station because the Affordable Care Act requires health plans to cover routine colonoscopies (in-network) with no enrollee cost sharing. See ACA FAQ XII. Indeed, the article quotes a surprised patient as follows:
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.The article quotes a researcher
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.Can the genie be put back in the bottle? Unlikely. The article accurately notes that
[T]he United States health care industry is nimble at protecting profits. When Aetna tried in 2007 to disallow payment for anesthesiologists delivering propofol during colonoscopies, the insurer backed down after a barrage of attacks from anesthesiologists and endoscopy groups.Indeed at the time that the ACA was enacted, a federal panel of medical experts sought to pull back on routine mammograms and Congress overturned their decision. This is the first of a series of New York Times articles basically urging regulated healthcare pricing for everyone.