In some ways, US healthcare is already very aggressive for some forms of preventive medicine. Compare the colon cancer protocols across the world. Basically nobody else is recommending colonoscopies to the entire population with no cheaper tests, but that's the standard of care in the US. It's not free to receive, and it's expensive in general, but for some reason in the US it is standard, instead of starting with non-invasive tests.
And yes, regarding smoking, the US has had one of the most effective preventive actions in the world. Compare actual numbers of smokers in the US vs, say, Spain, France or Turkey. So it's not anywhere near as clear cut as what you are trying to make it sound.
Walk into a US gastro with a hang nail and you'll walk out with a colonoscopy requisition.
They make money on the procedure, not the office hours. And they write the standards of care.
That being said, my father delayed a screening, developed colon cancer, and now no longer has a colon. Would cheaper / higher compliance tests have caught it sooner? Hard to say.
That's not entirely true. For screening procedures it's mainly the USPTF that writes the standards. They take inputs from the gastroenterology community but the process is more holistic.
https://www.uspreventiveservicestaskforce.org/uspstf/
Insurance is mandated to pay for preventive colonoscopies with no patient responsibility. No coinsurance, no copay, no deductible.
https://www.cancer.org/cancer/types/colon-rectal-cancer/dete...
> The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of all colorectal cancer screening tests that are recommended by the United States Preventive Services Task Force (USPSTF). The law stipulates that there should be no out-of-pocket costs for patients, such as co-pays or deductibles, for these screening tests.
Smoking ironically saves in medical costs because people die before getting into real expensive age related care, and also smoking disqualifies you from a large number of medical procedures that would otherwise be given. Keeping a relatively healthy 90 year old alive for 2 more years costs significantly more than keeping an unhealthy 60 year old smoker alive 10 more years before they have a heart attack or stroke.
How do you figure? I know several smokers who are now over 60 who had gotten lung cancer, becoming unhealthy and costing 200k each chemo session.
It is in lifetime medical care costs and there have been a few studies in Europe. The majority of medical costs is for age related care that grows exponentially with age, and smoking cuts decades off their life. Most smokers die before they get lung cancer, when they do it rarely results in surgery because they smoke, and it is easier to give a younger person chemo than and older person.
Also have you seen the kind of medication regimes that most 90 year olds take? Many of them take as many pills in a week as a 60 year old has took over the last decade or more.
You did not say lifetime medical costs initially but compared adding 2 years to a 90 year old vs 10 years to a sick 60 year old.
> Keeping a relatively healthy 90 year old alive for 2 more years costs significantly more than keeping an unhealthy 60 year old smoker alive 10 more years before they have a heart attack or stroke.
Population statistics
Population statistics showing it is cheaper to prolong the life of an unhealthy 60 year old for 10 years than a relatively healthy 90 year old for 2?
> Basically nobody else is recommending colonoscopies to the entire population with no cheaper tests
I'm not sure if I understand what you're saying. Kaiser Permanente sends me a take-at-home colonoscopy test every year, and some light googling suggests the cost is $20-$89. I've never done an in-person colonoscopy, but the home version must be cheaper, right?
Unless you're putting a camera into your colon, it's not a colonoscopy
they're referring to a screening kit like this: https://www.cologuard.com/
That's not a colonoscopy. It's a colon cancer test, but not a colonoscopy, which, by definition, involves a scope.
Camera-pill?
Based on my personal experience with Kaiser and their home fecal test (FIT test) as a cheaper screening method, I suggest opting out of it and insisting on a colonoscopy.
The problem is that the fecal tests are totally inconclusive. Every positive test must be confirmed by a colonoscopy. And then you get into tricky waters with insurance. My Kaiser gastro doc insisted that my colonoscopy after a positive home FIT test would be billed as diagnostic and not covered at no charge as preventive screening. Which means I would pay over $2k. Despite the USPSTF publishing explicit guidance on this exact scenario still being screening. He was dead wrong, and I wasn't billed, but he and his department did everything they could to discourage me from following up with a colonoscopy.
And at one point he even turned the tables around on me and said this was all a consequence of my having opted for the FIT test instead of a colonoscopy. Which I never did, I was not given a choice. But from his statement I would assume that you can opt in to colonoscopy instead at Kaiser. Then again this could be yet another piece of misinformation on his part.
Kaiser has some very opinionated beliefs that their medical leadership pushes. From my partner's T2D issue (from no history to an ICU stay with DKA): "You cannot go into remission with T2D". "You will need to keep your A1C between 6 and 8 otherwise you will have issues with the medications you are on". They also have many medications they will not prescribe, regardless of the reason.
And don't start me on their pharmacy. She had root canals with some infection, and was in substantial pain. Dentist prescribes short term pain meds between procedures - she's in agony. I drive her from dentist to the Kaiser pharmacy at their UC/ER-lite/whatever facility, that I know from my previous work as a paramedic has pain management medications on site (day surgery, etc.)
"This is a pain management prescription. We do not fill those in person. You will need to submit it to our mail order." "How long will that take?" "5-7 business days, and then shipping time."
"Oh, look at you, coming from the dentist with verifiable surgical procedures done and in pain - just in case you might be drug seeking, you can hang on for a week or two and get your pain management then."
That last one is, I'd argue unethical and against most pharmacists "oaths".
I haven't heard of a take-home colonoscopy. How does that work?
The take home thing is a vial into which you put a stool sample and mail it back. Then it gets tested for signs of colon cancer. I've seen them advertised on TV as well.
That is not a colonoscopy. That is a stool sample and as other replies noted this gets sent out every two years to every one. In the UK from age 60 Australia seems to be from 50.
If that tests positive then you get a colonoscopy to check more things. If you have had colon cancer then you get a full colonscopy evry two years and an MRI every year.
Right, it's an alternative to a colonoscopy. As standard-of-care it's relatively new in the US.
No it is not an alternative to a colonoscopy it is a different test.
If this test finds something then the next step is not treatment it is you need a colonoscopy.
It is a test that cuts down on the number of colonoscopies needed and is cheap enough to find problems earlier than everyone having a colonoscopy which is just unaffordable,
I've got extremely normal marketplace health insurance and my doctor is at an extremely normal overworked large regional health chain, and I would have to argue with him to get an at-home test; the whole system is set up to funnel us all into colonoscopies.
Replace colonoscopies in that sentence by anything that can be made money from and pays doctors.
Sigh, we’re so far behind in anything that’s actually good for the common person. We’re way ahead in capitalistic societal development, though.
This is standard in Australia. Everyone between 50 and 74 receives a free kit in the mail every two years, and there are regular TV ads from the federal government (featuring actual TV stars) encouraging everyone to do the test and mail the results in.
The home version is cheaper, and inferior
Hypothesis: The American diet contains more carcinogens (dyes, additives, pesticides, supplements in poultry/beef/pork) and therefore USA is is more need of CRC screening.
USA generally has higher CRC rates than other developed nations:
https://pmc.ncbi.nlm.nih.gov/articles/PMC2796096/
the screenings may make sense, here
I think that article is from 2009. Need something more recent. Also it mentions that as countries become high-income economies, the incidence rate increases.
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Based on 2022 data, rates are lower is US compared Japan, Russia, Italy, France and UK.
https://www.wcrf.org/preventing-cancer/cancer-statistics/col...
Maybe that implies more dyes, additives, pesticides, supplements in poultry/beef/pork in those other countries?
My doctor in the US did everything he could to tell me that my screening colonoscopy would be charged as diagnostic and I would have to pay over $2,000 for it, despite no history or indications of a problem. So it isn't all a bed of roses.
Most insurance covers preventive care, so that’s why it’s popular