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Another Bit of Nonsense in the Cost of Health Care

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Dick Hall-Sizemore
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Colonoscopy
Image credit: Johns Hopkins University

by Dick Hall-Sizemore

I just had an experience that illustrates the bewildering complexity of the finances of the American health care system.

Yesterday, I had a colonoscopy. I’m a veteran of this procedure, having had several because there is a history of colon cancer in my family. (No polyps this time, by the way.)

The protocol for the dreaded “prep” time has changed. No longer does the patient have to consume a gallon or two of sickening sweet liquid (others who have had this procedure know what I am talking about). Now, one has to take 24 pills in two stages between 6 p.m. the night before and 6 a.m. the day of the procedure, along with a lot of water.

Under my Medicare Part D prescription drug coverage, the pills would have cost me about $150. However, my doctor gave me a coupon from the pharmaceutical company, with which the pills cost me $40. To use this coupon, I had to go online and activate it. As part of the activation, I had to certify that I had Medicare Part D insurance, agree not to seek reimbursement from Medicare or a Medicare Advantage prescription plan for any out-of-pocket expenses in purchasing the drug, agree not to count the cost of the drug toward my deductible, and notify my prescription plan that I have purchased the drug outside of my plan benefit.

In summary, I was eligible for the reduced cost if had Medicare and a prescription plan, but I could not use that prescription plan to get the lower cost. In what world is this a sane way to run a health care system?

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24 responses to “Another Bit of Nonsense in the Cost of Health Care”

  1. LarrytheG Avatar
    LarrytheG

    It’s truly an Alice-in-Wonderland Rabbit warren of a system, no question but I don’t have much confidence that somehow anti-trust or price transparency will help it and/or make it easier to “shop” for lower prices.

    And the thing is, I am familiar with the ACA (Obamacare) as well as the FEHB (Federal health care) as well as Medicaid – all of which offer multiple choices of insurance and coverage but not a one as far as I know will help one navigate their way through a given colonoscopy or even an MRI procedure.

    They all want to know your insurance, then they will endeavor to help you figure out your co-pay costs and ways to lower those costs. At that point in the process, I have no clue how I would be able to pursue a different path with possibly lower costs much less be able to seriously compare the quality of the care or the experience of the providers, etc, etc.

    I have one of them coming up and those pills sound wonderful compared to the gallon of UGH!

    Thank you Dick for your post and so glad it’s not one of those “hit” pieces that rile up some BRers! 😉

  2. Nancy Naive Avatar
    Nancy Naive

    The last time the spousal unit had a colonoscopy, she had to drink 64 oz of Gatorade, any color not green or red, and take four — count ’em, 4 — Dulcolax. That was it. Oh yeah. Broth and clear soups no solid food for the two days prior. No nuts, corn, and list of other things 4 days before.

    1. LarrytheG Avatar
      LarrytheG

      YOW!

      1. Nancy Naive Avatar
        Nancy Naive

        What I neglected to say explicitly was that the “purge” was accomplished for under $10 with an OTC laxitive and sports drinks.

        That’s a huge price drop. A far cry from the prescription yuch.

    2. tmtfairfax Avatar
      tmtfairfax

      Been there; done that. Hopefully, the next one will be the pills.

      1. Nancy Naive Avatar
        Nancy Naive

        You still need to stay hydrated, and GatorAde replaces the electrolytes. It just isn’t the big jog-o-crap, which if I recall was called “Go-Lytely”.

        GatorAde. Reminds me of an old 1970s SNL skit.

  3. Nancy Naive Avatar
    Nancy Naive

    Speaking of moving things, I just realized that ending the filibuster will nip any fear of inflation in the bud.

    1. John Harvie Avatar
      John Harvie

      Not so sure since Congress, both parties will then have a license for uncontrolled spending. They both have used it before and will again I believe.

      1. Nancy Naive Avatar
        Nancy Naive

        John, with the filibuster, power is vested in the majority and minority leaders, and the one or two senators that jump out first for, or against, the legislation. Without it, power spreads to all, nearly equally.

        With the filibuster it takes 10 or 12 senators to assure passage. Without it only 1 to 3. Buying 12 senators is expensive. Only the top tenth of one percent can afford it. Buying 2 or 3 senators any 1%’er can do. That’s a massive increase in buying power.

        You drop the price of legislation that much, all other commodities are bound to follow.

        1. John Harvie Avatar
          John Harvie

          More than a simple majority should be required for ANY spending. If if makes sense getting the requisite votes won’t be a problem. Keeps down the frivolity at least to some extent.

          For other than spending it can and has been abused like Strom Thurmond in re Jim Crow on civil rights some years ago, maybe before your time. At least he actually stood on the Senate floor and spoke/read for the 24 hours.

  4. James A. Bacon Avatar
    James A. Bacon

    Health care pricing is mystifyingly opaque. Without price transparency, a market economy cannot function. That’s one big reason why health care in this country is such a mess — it’s not part of the market economy.

    1. John Harvie Avatar
      John Harvie

      Not sure what you mean by price transparency. When my late wife passed in Dec 2016 after a relatively simple 10 days in Sentara Leigh, and with having no OR or Herculean procedures her detailed bill was a bewildering listing of charges. It was transparent, I guess and was many pages long, but still unfathomable to me.

      1. Nancy Naive Avatar
        Nancy Naive

        Codes and prices, meaningful only to a 30-something at the insurance company’s computer. Sorry for your loss. Remember, it’s never too late. Seek companionship — always.

    2. Nancy Naive Avatar
      Nancy Naive

      That’s all on the hospitals and providers with their “Master Books” and piecemeal pricing. Then add on that the insurance companies as a payment plan, less 20% for profit, ULM bonuses, etc., rather than honest brokers and you get what we got.

      But to think that the consumer alone will/can actually shop is ludicrous. You need an honest, nonvested, informed reviewer with clout. Who dat?

      Plus, we Americans are a strang lot when it comes to healthcare. We either ignore our health, or become fearful and easily preyed upon.

      1. Dick Hall-Sizemore Avatar
        Dick Hall-Sizemore

        Plus, price shopping is sometimes not possible or impractical. Two examples: When I was suddenly doubled over by a kidney stone a few years back, I sure did not take time to determine which emergency room was the cheapest. I headed for the nearest one.

        Next month, I am scheduled to have a simple outpatient procedure, the removal of a metal plate from my wrist that was placed there about 20 years ago. (It now is causing problems.) My doctor gave me the choice of two hospitals–one on this side of the river and fairly close to my house and one across the river in far western Chesterfield–about 45 minutes away. So much for price shopping.

        1. Nancy Naive Avatar
          Nancy Naive

          Plus, even if you could ahop and if there were a difference in price, “you get what you pay for” is niggling around in the back of your brain, too.

  5. Nancy Naive Avatar
    Nancy Naive

    My experience with colonoscopies has been one every 3 years, or so, since 2001. The first was under a sedative and I watched the monitor until the “painful turn” when they added enough to the drip to put me under. The last was out like a light using propofol (Michael Jackson’s drug of choice).

    The cost in 2001 was $1800. In 2017, it was over $8000. Pre-negotiations.

    The results was the “removal” and biopsy of 4 benign polyps every single time. Hmmm, the same 4? They couldn’t tell me. Apparently, they didn’t/don’t map them. They did say I can go 5 years. I’m thinking maybe 10.

    It’s a treadmill.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      I have had one every three years as well. For the first one, I was awake through the whole thing and got to watch the monitor. Pretty cool. Since then, I have been out like a light. Good nap. Not any trouble shaking the anesthesia after I wake up.

      If you have had four polyps every time, you should not wait even five years, much less 10, for your next one.

      1. John Harvie Avatar
        John Harvie

        I had an endoscopy and colonoscopy some years ago from Dr. Pike (a great doc now moved to CA; Tidewater’s loss). I saw something on the monitor and inquired if that might be a polyp. He said yes and proceeded to snip it off.

        Prior to the procedure and with a wry smile his nurse said words to the effect that after they went in the back door they’d use the same appliance to look down my throat. Not true, of course. She and I had a good chuckle.

      2. Nancy Naive Avatar
        Nancy Naive

        I think the doctor marked my chart for general anesthetic after the first time because of the constant stream of bad jokes.

        It started with, as he was approaching with the garden hose and the target filled the monitor, “Oh dear God, I do need to diet!”

    2. energyNOW_Fan Avatar
      energyNOW_Fan

      I recall liking the propofol. Waked up feeling like I had good power nap.

      1. Nancy Naive Avatar
        Nancy Naive

        I did not like it at all. Woke dazed and confused (as opposed to the political labeling “Woke, Dazed, and Confused”) and took me 5 minutes to speak coherently. Scared the piss out of my spouse and the nurse.

  6. Becky D Avatar
    Becky D

    I am on Revlimid, a cancer drug taken as pills at home. The cost is $16023 per month. Under Medicare Part D, my first month’s copay this year was $3164 and subsequent months are $913. However I was able to apply for patient assistance through the drug company’s foundation once I had paid over 3% of last year’s income. Once that started, there is no cost either to the Medicare D insurance company (it doesn’t come from the insurance company’s pharmacy but from the foundation’s own specialty pharmacy) or to me. It’s my understanding that the insurance company gets reimbursed from the federal government for much of what they pay the drug manufacturer, so being on patient assistance is saving all of us a substantial amount. It’s crazy. There no good reason why the price should be so high.

    1. John Harvie Avatar
      John Harvie

      Unfortunately you are not alone. One of my stepdaughters, a 40 year Chron’s sufferer has been on many such drugs and has been through multiple clinical trials. She mentioned the other day her current drug, I forget the name comes to around $25k a month. She makes their catastrophic plan’s deductible in January every year.

      I suspect the $millions in developmental cost of many of these drugs and the limited market for some are at least partly to blame. I don’t rule out greed and/or “whatever the market will bear” for the rest. The drug companies also explain that for every successful drug coming to market many others they tried to develop didn’t pass trials, thus a loss of developmental costs. The relatively short patent protection time limit probably bears some responsibility too.

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