Elisabeth Rosenthal’s piece in The New York Times today is receiving the customary “it’s the prices, stupid” applause and “I told you so” on Twitter, including from me. However, a reader writes me with another view that’s worth sharing.
I left it with the opposite impression of everyone on Twitter. The take-home seems to be “its the prices,” but I’m not seeing that.
In this article, the primary problem was not that we pay more for colonoscopies, we’re buying different things! The colonoscopy was a little more expensive, but the real difference in Europe was that we also buy an anesthesiologist and a surgical center along with it.
It’s like buying pasta with or without truffle oil – of course it costs more, that doesn’t mean the pasta with truffle oil is priced too high.
Why’s this matter? It would lead to totally different policies. If it’s the prices, the secret would be to decrease pay scales. If it’s overuse (in this case, overuse of surgical centers and anesthesiologists, not colonoscopies) then we need more oversight or a more complex adjusted capitation system. (Would ACOs be enough to fix this?)
Indeed, it can be both prices and “intensity,” if not volume. Volume can be coarsely measured as visits and scans and such, but intensity — roughly how much we load up each procedure with ancillary stuff — is less frequently considered and is what my correspondent is getting at. Do you agree? Go read Rosenthal’s story and express your view in the comments.