Nicely written but it doesn't shine a light on why this is a very good example about why US health care costs are out of control. I too had a colonoscopy but I refused to be anaesthetised. It is a considerable part of the cost and absolutely unnecessary. Is coloniscopy pleasent? No. Is it painful? No. But you should have seen the bruhaha my desision caused. Three nurses and two doctors tried very hard to convince me to be anaesthetised. I had one before without it so I knew what to expect. It erases ~ $3k from my bill. Or the hospital's revenue depending on your point of view. No doctor even suggests or offers it that way. In the EU it is standard procedure.