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EDITORIAL: Harder to decipher than Doc's writing

Virginian-Pilot (Norfolk, VA)


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 the study.

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 actually cost.

Informed consumers can make good decisions. Without them, an entire industry exhibits symptoms of distress.


(c)2013 The Virginian-Pilot (Norfolk, Va.)

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