Americans spend too much on health care. Nearly everyone agrees with that, even if most can't say exactly what to do about it. The simple solution is to cut wasteful spending.

But there is nothing simple about cutting health care spending. A case in point is screening for colorectal cancer. About 150,000 new cases and roughly 55,000 deaths from the disease occur in this country each year. The death rate from colorectal cancer, like those of many other cancers, has declined over the last 15 years. That success is due at least in part to more widespread screenings, which allow doctors to catch the disease at an earlier stage when it is easier to cure.

Screening is much cheaper than treating colorectal cancer. The public health is best served by screening for individuals at risk — those over the age of 50, or with a personal or family history of the disease. That's why Medicare and most private insurance plans pay for it.

But not everyone gets screened. It requires a colonoscopy, which means a doctor must insert a long flexible scope through the rectum into the colon. And while that procedure can be performed on many people using what's called conscious sedation, others refuse to even contemplate it without stronger pain control.

There is another option, one gaining popularity among the squeamish. It involves a drug called propofol, which provides deep sedation of the kind most associate with a general anesthetic. But the price of the drug, and the fact that it must be administered by an anesthesiologist or nurse anesthetist, adds an additional $250 to $400 to the cost.

Some insurance companies have looked at those extra costs and decided they're not significant. Others, notably Blue Cross/Blue Shield of Missouri, have decided they will no longer pay for propofol except in certain cases. Adding to this complexity are doctors' financial interests. Using propofol allows them to perform more procedures on a given day, which means they make more money. There's no question that many doctors believe colonoscopy with the drug is better for their patients, but how much of their enthusiasm is colored by self-interest?

Insurance companies could make patients pay the extra out-of-pocket. But many people don't have the money, which means some will skip the screening. That brings us to our final complication.

What we pay for health care, directly through insurance premiums and indirectly through taxes, is related to the cost of caring for everyone in America — insured and uninsured alike. An insurance company may save money in the short run by not covering the drug. But if fewer people are screened as a result, and more advanced cases occur in years to come, we all end up picking up the tab. Business, government and insurance industry leaders want to eliminate wasteful spending, as do consumers. But, to quote the doctor, this may involve some discomfort.