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**Introduction: A Few Questions to Set the Stage**

**Should you trust your doctor?** Is the medical system organized and controlled by the modern equivalent of highway robbers? What can we learn from the way colonoscopies are promoted and priced in America? What is the single most important takeaway lesson from a brief exploration of these questions?

**Here are short answers to the first three of these rhetorical queries.** I’m saving a response to the last question (i.e., recommended course of action) until the end. **No, don’t trust your doctor**, if you are fortunate enough to have ready access to one or more medical practitioners. Instead, **be wary and verify**, do independent checks on the pertinent issues and obtain other qualified opinions. Doctors and other providers are not your enemies but they’re definitely not your friends, either. They are highly trained professionals who function in a complex dysfunctional system oriented to profit. Most want to do the right thing but pressures brought to bear can lead even ethical practitioners to justify action courses not be in your best interest. In this essay, I’ll make the case that your interests and the public interest take a back seat to a higher power of sorts – the profit motive. Yes, the medical system is highway robbery, circa 21st century. Plenty can be learned from a close look at the colonoscopy industrial complex. The procedures being performed can serve as canaries in the American medical system coal mine. Pay attention, be alarmed and do what you can to save yourself before it’s too late.

**Colonoscopies, Medical Providers and Free Enterprise Run Amuck**

**Colonoscopies are the most expensive routine screening test in this country**. A report by the Commonwealth Fund revealed that this procedure is billed at rates ranging from $6,385 to $19,438. (See Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, May 3, 2012, Volume 10.) These figures are retail rates for the uninsured; insurers usually negotiate prices down to about $3,500. Americans fortunate enough to have employer-based insurance often assume that medical care is basically free, despite rising co-payments and deductibles, but it’s not. Seniors on Medicare make the same mistake, often because they are exhaustipated (i.e., too tired to give a crap).

Like the high costs of our wars in Iraq and Afghanistan, everyone pays in the end, no pun intended.

In other Western countries, the price tag for a colonoscopy averages out at a few hundred dollars. Contrast this with the U.S. experience:

**Americans pay more for almost every interaction with the medical system**… A list of prices compiled by the International Federation of Health Plans found that medical services are more costly in every category – by a huge margin.

**Forms of Highway Robbery in America’s 4th Century**

In case you have been on the moon or otherwise out of touch for several years, here’s a summary of why so many experts believe the U.S. medical care system is out of control:

1. Doctors prescribe expensive procedures. However, the high price tag of ordinary ones accounts for our $2.7 trillion annual medical care tab – 18% of GNP. ((Source: Elisabeth Rosenthal, Paying Till It Hurts: A Case Study in High Costs, New York Times, June 1, 2013.)

2. Doctors promote too many tests. According to the CDC, more than ten million Americans each year undergo colonoscopies (at a cost of $10 billion annually). One motive for so much testing is defensive medicine. America is as litigious as it is religious. Doctors are required (or pressured) by insurance regulations or their employers/partnerships/professional associations to prevent lawsuits, rather than to patient impoverishment or even bad health outcomes.

3. Pharmaceutical companies saturate the media with direct-to-consumer merchandizing. The saturation ad campaigns for drugs for whatever does or could ail you distorts patient judgments. Consumer appetites for quick fixes are encouraged. Patients are motivated to pressure providers for overpriced, overrated products.

4. Greed rules. So-called non-profit hospitals, insurance companies, device makers and other players in the medical industry are focused on generating the highest possible profits they can legally justify. The quest for maximum returns is by far the number one objective in the American medical system.

5. High tech, drug-focused treatments dominate. A disproportionate amount of medical care and expense is lavished on chronic conditions in later life, leaving fewer resources for prevention, education, and acute care. Cost/benefits take a back seat. Substantial medical care is lavished on ministrations that simply extend the dying process.

6. There are too few incentives to act sensibly. Overlooked in studies to explain the high costs and poor return on medical investments relative to other industrialized countries is a disturbing reality: Americans are overly fond of guns, gods, demigods, and drugs. They are too little committed to reason and critical thinking, exercise, whole food plant-based dining, and the art of shaping supportive environments for themselves and others.

**Colonoscopies As Coal Mine Canaries**

The colonoscopy gets my vote as the biggest scam in modern medicine. We should stop using the term colonoscopy – colonoscamy is much more descriptive and appropriate. The biggest scam distinction is no small honor or rather dubious distinction, given the abuses that could and have been documented about the U.S. healthcare system. Colonoscopies are marketed by fear tactics, not unlike religions. The high possibilities of horrific torment and premature death from colon cancer are sometimes described with almost wicked delight by colonoscopy counselors.

A year ago, I reluctantly agreed to sit for a pep talk by a renowned proctologist. The topic was why I should have a colonoscopy, despite no risk factors save old age. I consented to the interview only after years of get a colonoscopy badgering by friends, family members, and varied medical practitioners, including even my dentist! The graphic descriptions of dire consequences of failing to detect a polyp would have done Hieronymus Bosch proud. I was reminded of the visions drawn by nuns 65 years or so ago at St. Barnabas Parochial School. The eternal hell-fires were described in such fine and vivid detail anyone would have been convinced the nuns had been there. I think all this fright was designed to ensure that I never missed a mass on Sundays. (For a while, I didn’t, though I did arrive as late as possible so that my being there still counted.) So I listened to the colorful colonoscopy pitch – and still decided not to do it. (I even wrote an essay about the interview experience.)

**Colonoscopies are billed as quasi operations**. What a short time ago was a simple office procedure has morphed into a more complex booming business. Now there are surgery centers where lucrative colonoscopies are prescribed and performed in excess of medical guidelines. The goal is to maximize revenue; lobbying, marketing, and turf battles among specialists, plus huge profit margins, account for the high costs. Other tests for colon cancer are less invasive, cheaper, and equally effective.

Australia does not even pay for colonoscopies as a standard screening procedure and it is not common in other western nations, either.

**The American Free Enterprise Anomaly**

In this country, the government, unlike in any other industrialized nation, does not regulate or otherwise intervene in medical pricing, other than setting payment rates for Medicare and Medicaid. Other nations view healthcare as a right for all and regulate hospitals and the rest of the delivery system as public utilities. What conservatives like to call a free market is not so free for consumers.

Imagine if you went to a restaurant and ordered your meal with no clue what the dinner would cost. Imagine the anxiety waiting for the waiter to arrive with the check. Or, apply the medical care model to other normal purchases, large and small. What if the supermarket groceries you loaded up, took home, and consumed were added up and recorded in your account, but you did not see the bill for days or weeks, well after you processed most of what you carried off! Such transactions are ridiculous, of course, and yet that’s how it is in the medical system. I sometimes receive bills for medical procedures rendered a year earlier, after the hospital or medical practitioner has given up on negotiations for full or good…
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Ihab Salloum