In a comment two weeks ago ["Medicare Visits Utopia No errors allowed"] we noted that legislating too many medical mandates on doctors, as in Medicare, will have the unplanned consequence of driving physicians to opt out of what has become a sham-system.
In this week's column we note another bizarre consequence of medical insurance suggesting that for some patients no insurance is better than make-believe insurance.
Patients seeking an appointment with a dermatologist for Botox treatment of wrinkles can generally get in within a week or two. But if they are worried about a potentially life-threatening cancer, such as a changing mole, they may have to wait months.
"The difference in wait times between medical dermatology and cosmetic dermatology patients is clearly real," stated Dr. Jack S. Resneck Jr., assistant professor of dermatology at the University of California at San Francisco. Resneck is the lead author of a study to be published in the Journal of the America Academy of Dermatology.
According to its abstract, the study "cannot differentiate between many possible explanations for the observed differences in wait times. Because physicians in many other specialties with physician shortages are also offering cosmetic services, further studies are needed to assess the broader policy implications of these findings."
"The study shows that the Botox needs of the United States are being met," states Dr. Alexa B. Kimball, associate professor of dermatology at Harvard Medical School. There is a wide array of doctors including plastic surgeons and even some internists offering Botox injections, but the demand for medical dermatologists, in an age of increased awareness about diseases like melanoma, outstrips the supply.
Other dermatologists note the role of financial incentives. Dr. Michael J. Franzblau, a San Francisco dermatologist, notes that patients frequently pay $400 to $600 upfront for a Botox anti-wrinkle treatment, which typically is not covered by insurance. Meanwhile, doctors have to wait (months) for insurance to pay them $50 to $75 for a mole examination (New York Times 8/29/07).
Dr. Resneckšs comment that "we need to look further and figure out what is leading to shorter wait times for cosmetic patients" is "clearly laughable" writes internist Alieta Eck, M.D., of Somerset, N.J.
"It has been obvious to us all that anything that is not covered by insurance is completely available today. Chances are, if a procedure is covered by insurance, the payments do not cover the costs, so fewer and fewer doctors are available to do it."
Dr. Eck notes that an obstetrician in her area does cosmetic vein and Botox treatments to subsidize his obstetrics practice.
Likewise, a gynecologist is Newport Beach, Calif., now specializes in cosmetic vein treatments.
"Doctors need to bail out of insurance completely and take back the practice of medicine," Eck writes. "Patients need to be responsible for their bills, and can use the insurance instrument to pay them, but the patient-doctor relationship needs to come first."
So as the essentially impossible to follow and time consuming government mandates increase and the payments from private insurers decrease more and more physicians will opt out for procedures that allow them to recover their costs.
We have "managed" to create an unholy insurance system where sometimes the best insurance for the patient is no insurance at all.
Thank you Wall Street.
Thank you insurance company presidents.
Thank you penny-pinching Medicare administrators.
Thank all of you for providing the patients with faux insurance.
Editor's Note: Michael Arnold Glueck, M.D., submitted this week's commentary.
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Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in Economics and Citizenship at the International Trade Education Foundation of the Washington International Trade Council.
Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
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