Up Proctoscope!

There is no such thing as a free lunch.

Attributed to Milton Friedman (1912-2006)/b>

August 25, 2011 - When I think of colonoscopies, I think of movies starring Clark Gable, Burt Lancaster, and Sean Connery, in which the submarine captain shouts “Up Periscope!” He wants to rise the periscope to take look around to see what dangers lurk on the horizon.

With colonoscopies, doctors seek to rise up their instrument up the colon to visualize what dangers lurk inside - a polyp, a cancer, an inflammatory disease, a blood vessel anomaly. They bring with them their flexible colonoscope bearing cameras to document what they see, instruments to snip off polyps, and biopsy tools.

Mainly they seek to nip in the bud early colorectal cancers, which, when they progress, kill more than 50,000 Americans each year. Health authorities advise routine colonoscopies after age 50. Colonoscopists may also perform them to detect sources of positive occult blood tests, gastrointestinal hemorrhage, or iron deficiency anemias.

In the interest of prevention, the Patient Protection and Affordability Act (PPACA), Obamacare, pays for “free” colonoscopy screening. Many consider these free colonoscopy screenings as a truly commendable benefit of the new health reform law, as indeed it may be.

As with any “free” government benefit, however, there is a catch.

Colonoscopists find a lesion, the colonoscopy may not turn out to be “free.”

As Kaiser Health News reported on April 25, 2011, “Under Health Law, colonoscopies Are Free, But It Doesn’t Always Work That Way,”colonoscopists find a polyp in 25% of men and 15% of women, and many insurers charge for removal and biopsy of polyps and other lesions. These charges produce financial “post-procedural shock,” meaning what was thought to be "free" wans't. Even Medicare charges patients a copay of $186 plus 20% of the doctor’s fee. As proctoscopies have morphed into sigmoidscopies and into flexible colonoscopies, and as procedures have morphed into therapies, the concept of a “free lunch” is being challenged.

Tweet: Many insurers, including Medicare, are charging for therapeutic measures found in health reform "free" colonoscopies.