@CTBarrister It’s certainly true that propofol costs considerably more than conscious sedation, and that can influence what choices are offered or encouraged. It’s not true that these are equivalent experiences, though. Propofol tends to more completely wall off any awareness of the procedure, and the recovery from propofol tends to be very quick and complete (vs. a much slower recovery from conscious sedation). For something like screening colonoscopy propofol leaves people more likely to return for their next screening, and broad acceptance is the only way screening programs succeed. If any sedation at all is needed for pouchoscopy (which is brief and in most cases only mildly uncomfortable) the quick recovery advantage still applies to propofol.
When making an argument about sedation choices the question comes down to “is the propofol worth the additional money?” You appear to be arguing that it never is, but that really depends on the individual. Why not argue that *any* sedation is an unnecessary expense? When insurance companies make choices about health care they are strongly biased toward lower costs, just as providers may be biased toward higher costs. The provider, though, will also care about my experience, comfort, and well-being, at least if I’ve chosen a decent provider. In my experience the insurer tends to be indifferent to these things.