As part of my preparations for my retirement (29 days!)I recently went and made arrangements for a colonoscopy. It's been five years since my last one, and for someone of my age, that is the recommended time interval between routine screenings. Or so I thought, my doctor advised me that the insurance companies had changed the recommendations and increased the time interval. Yes, this health care is now subject to rationing; after all, the cost to the insurance company is now $2500! Of course, if a potential problem is not caught early enough, it could cost them much more, so I suppose their actuaries have now determined the financial break-even point to be somewhat longer than five years. Medical considerations have nothing to do with it, as the specialist pointed out to me.

So I asked him, what would be a reasonable time interval? The answer, as I deduced during our discussion here when Obama's health panel caught political hell for trying to extend the interval between mammograms, is strictly a numbers game. The more often you do this, the more people you save, but the more it costs. When you factor in the money it takes to treat an advanced case that would have been detected by an earlier screening, the balancing expense statistics are what defines the optimum interval between screenings. Of course, the equation is modified by factors like age and medical history, but essentially, it is a statistical cost optimization: most bang for the buck, the maxima and minima of interacting mathematical functions. Human health and medical considerations are subordinate to financial calculations. Insurance, after all, is a business.

But hospitals are businesses, too. And the doctor gets paid for every colonoscopy he does. So I could tell he was very keen to come up with some mitigating medical circumstance that would justify my getting the examination earlier than the new recommendations allowed. He subjected me to a lengthy and detailed interrogation about my bowel habits. Eventually he decided my mild morning diarrhea (which I had attributed to an increased sensitivity to Cuban coffee due to my advancing years) warranted him taking a look. We had a mission!

For my part, I have been paying into my insurance plan for the last five years since my last examination and I was determined to get my money's worth. After the end of June, I would be relying on the Veteran's Administration doctors and guidelines to make this determination, and I had no guarantee what they would decide. So I was glad it turned out the way it did in the end. You see, I'm a business too.