10.1.19

THE CASE FOR TRADE-TESTED BETTERMENTS.

Milwaukee Journal-Sentinel columnist Jim Stingl discovers that insurance companies pay for colonoscopies on the basis of the code by which they are ordered. "How can one colonoscopy be entirely covered by insurance because it's deemed to be a preventive screening and the next cost us thousands of dollars out of pocket because it's labeled slightly more ominously as diagnostic?" It's a Through the Looking Glass version of Ronald Coase's "Theory of the Firm" in which one of the principal costs of avoiding the price mechanism is determining who has the primary right to avoid.
"Minutes before swallowing the gallon of colon blast, I got a call from my insurance company telling me that my copay would be $3,100. Gulp. Turns out I am now flagged and any colonoscopies from this day forward will be considered diagnostic, not screening," [Journal-Sentinel reporter Meg Kissinger] said.

"When I challenged the nurse on this, she told me that they hate this policy and blamed it on the insurance people. The insurance people told me it was the government, which I took to be code for Obamacare," she said.

The doctor scheduled to perform the test actually is employed by Madison Medical Affiliates, which gives patients a one-page guide to screening versus diagnostic colonoscopies. In short, it says screening applies only to tests done every 10 years and with no evidence or previous history of polyps, cancer and such.

The guide offers an excellent piece of advice to us patients who, let's face it, need to be informed advocates for our own health care these days: "Know the difference and what your insurance pays for."

Meg shared the story with her family doctor, who commiserated with her but urged her to shell out the money for the test. It's hard to argue against a procedure that catches cancer early.
Yes, although we haven't gotten into whether "the government" refers to Wisconsin rules, which involve a state that opted out of Obamacare in part, or what the risk premium is for follow-up procedures after five years, which is the recommended practice in the case of some polyps, or for that matter, what the opportunity cost of a colonoscopy is, irrespective of the surgeon, the operating studio, or the condition of the patient.  What matters, though, is that those market tests are absent.  Should they be?
It all seems so arbitrary, like charging more to check the brakes on your car because they happen to be squeaking. Why not just call every medical screen a diagnostic and save the insurance companies zillions of dollars on the backs of their customers?
Once upon a time, the automobile repair shops had this manual of standard service times, which meant there was a line item for "hours required to check squeaking brakes" broken down by make, model, and year. That, at least was semi-public information.

These days, the automotive analogy might be connecting the computer to read the codes your check engine light has stored in memory.  At some shops, there's one of those standard service fees to connect the computer and retrieve the codes.  Other shops might just connect the computer while they're changing your oil (no later than the earlier of 5,000 miles or six months) and let you know what they find, or you can go to some of the auto parts stores and they'll do the readout for you.

Admittedly, that's not quite snaking a camera into a tight spot, and yet must the insurers and bureaucrats circumscribe the discretion of surgeons in the way the car technician would bridle at?

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