How the dominant use of expensive sedated endoscopies sheds light on how special interests in the healthcare industry pass unnecessary costs on to patients.
The passage of the poorly named affordable care act was supposed to usher in an era of reduced medical costs and-unexpectedly for those who popped the pabulum pills-those costs have skyrocketed as the promises of Obamacare ran headlong into the realities of medical insurance. The bleeding has been so severe that United Health, hemorrhaging close to $1 billion in losses, is poised to leave the health care exchanges next year-the prime culprit for all of that red ink. (http://money.cnn.com/2016/01/19/news/economy/unitedhealth-obamacare/index.html)
No one doubts that the federal health insurance overhaul has done little to rein in rising costs to both providers as well as consumers. All of these costs, however, cannot be laid at the Obamacare doorstep. Presidential candidate Hillary Clinton points to the drug companies as prime culprits-and promises to set a $250/month limit on what a patient would have to spend on her medications. (http://money.cnn.com/2015/09/23/news/economy/clinton-health-care-costs/index.html)
Clinton is not alone in believing that artificial price controls and government mandates can be used to control these rising costs. But, as one health care expert observes, “Proposals to restrain the cost of health care by imposing price controls ignore their long history of failure. Regulated prices prevent markets from efficiently allocating resources, leading to pervasive shortages and deteriorating quality, while stifling innovation and diverting care to inequitable black markets. (http://www.heritage.org/research/reports/2013/08/legislating-low-prices-cutting-costs-or-care)
Lost in all of the partisan bickering, however, is some actual good news. Costs are rising because people are living longer-and the older you get the more likely it is that your medical costs will rise along with your age. (http://www.bloombergview.com/articles/2015-07-31/spending-more-on-health-care-is-actually-sort-of-good)
The higher cost of living longer is one important variable that cannot be attributed to the expensive Obamacare jig saw puzzle. But what about the role of the health care industry itself? Are there forces within the industry that-in order to preserve their own profitability- actively attempt restrain competition from alternative procedures that will lower costs?
If we examine just one narrow area of medical practice-the dominance of the use of patient sedated endoscopies for the diagnosis of esophageal cancer-we would have to answer the question in the affirmative; and if it’s true in this one area, we can only imagine how widespread the practice must be. This dominance, a veritable monopoly, can be simply reduced to one salient factor: money. The facilities where the sedated endoscopies are performed receive a facility fee of up to $3,000/procedure.
There is, however, a cheaper and safer procedure available to medical practitioners: TransNasal Esophagoscopy. TNE is a safer, as effective, yet cheaper alternative to endoscopies. But its use is restricted by vested interests that stand to lose billions of dollars if patients begin to opt for TNE instead.
As NBC News reported in the tragic case of Joan Rivers; “Doctors perform about 8 million endoscopies every year in this country. They are very common but they also entail risks…” (http://www.nbcnews.com/watch/nightly-news/joan-rivers-death-raises-questions-about-endoscopies-325829187585)
How risky are they? There is approximately a 5% risk for “cardiopulmonary unplanned events”-with a percentage resulting in fatalities- and this risk is elevated for older patients like the famed comedian. At 8-10 million upper endoscopies performed per year in the USA, we are talking about 50,000 people annually who suffer these complications.
While far fewer die as a result of these adverse events, it is nevertheless a huge number of near catastrophic events involving a large amount of morbidity-and this is particularly true for elderly patients.( http://gi.org/wp-content/uploads/2012/10/6-ajg2012246a.pdf)
These risks are downplayed because of the power of vested medical interests. At revenues of 30 BILLION per year, the facility owners/managers have a strong financial disincentive to offer an unsedated exam that doesn’t require a facility. Conservatively, over half of the sedated endoscopies performed annually can be performed in a physician’s office using TNE without sedation, thereby saving the health care industry over 15 billion per year.
If there are $15 billion worth of savings through the use of a less risky but equally as effective procedure, then this is likely to be the tip of the iceberg. The public has a right to know about alternatives when sedated endoscopy is suggested by their doctors.
What we need are legislative investigations into the existence of a medical cartel that is actively conspiring to restrict the public’s knowledge and therefore the use of the TNE alternative-and other procedures that may exist behind the stethoscope carrying, white coated wall of silence. If collusion can be proven, law enforcement needs to become actively engaged.