August 29, 2007 12:44PM # Hmm… You Should Have Someone Look at That By [Michael F. Cannon](https://www.cato.org/people/michael-f-cannon) --- SHARE Americans usually criticize socialized health care systems for forcing patients to wait for care, so it’s a curious thing to find American patients waiting. It happens. I’ve [weighed in](https://www.cato.org/2007/07/25/darn-those-stubborn-market-failures/) on Americans waiting for care, as have [Tyler Cowen](http://www.marginalrevolution.com/marginalrevolution/2007/07/how-long-should.html), [Matthew Yglesias](http://matthewyglesias.theatlantic.com/archives/2007/07/in_soviet_russia_line_waits_yo.php), [Ezra Klein](http://ezraklein.typepad.com/blog/2007/07/more-waiting-ti.html), and others. Today’s *[New York Times](http://www.nytimes.com/2007/08/29/health/29cnd-skin.html)* now informs us: > Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, says a study published online today by The Journal of the American Academy of Dermatology. > > > Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared to a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin [cancer](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/cancer/index.html?inline=nyt-classifier). The article also provides this interesting contrast: > Dr. Michael J. Franzblau, a dermatologist in San Francisco, said doctors typically charged $400 to $600 for a Botox antiwrinkle treatment, for which patients pay upfront because insurance does not cover it. > > > Meanwhile, doctors have to wait for health insurance to reimburse them for mole examinations, for which they receive an average of $50 to $75, Dr. Franzblau said. This article reminds me of a 2005 [study](http://jama.ama-assn.org/cgi/content/abstract/294/10/1248?etoc) that called ambulatory clinics to see who is most likely to get an appointment for follow-up care after an ER visit. The study found, roughly: 1. “Four hundred six (47.2%) of 860 total callers and 277 (64.4%) of 430 privately insured callers were offered appointments within a week.” 2. People with private insurance and those who offer to pay cash up-front were more likely to get an appointment than Medicaid patients, who in turn were more likely to get an appointment than patients who offered to pay $20 up front and pay the balance later. 3. Nevertheless, one-third of those with private insurance — and even those who offered to pay cash up-front — still couldn’t get an appointment. When I discussed that study with my colleage [Peter Van Doren](https://www.cato.org/people/vandoren.html), he described it (with precision) as “an out-of-equilibrium situation not resolved by the price mechanism.” With regard to Medicaid, it’s easy to see what’s interfering with the price mechanism: Medicaid prices are set by state governments, and so they don’t change to eliminate shortages (i.e., waits) the way market prices might. The same is largely true of private coverage: those prices are set by insurers, who mostly just track [the prices that the federal government sets through the Medicare program](http://online.wsj.com/article/SB118101135977724637.html) \[$\]. But then why would there still be shortages for patients who come with cash in hand? The price mechanism seems to be working for cash-paying Botox patients, but not for cash-paying ambulatory clinic patients. One possibility is that there might be spillover effects that affect cash-payers in markets dominated by third-party payment and rigid prices. But then wouldn’t we see cash-only ambulatory clinics emerge to capture those customers? If not, that suggested [supply constraints](https://www.cato.org/pub_display.php?pub_id=2466) to Peter and me. ##### Related Tags [General](https://www.cato.org/general), [Health Care](https://www.cato.org/health-care), [Tax and Budget Policy](https://www.cato.org/tax-budget-policy) [![Creative Commons License](/build/cato_2020/images/creative-commons.svg)](http://creativecommons.org/licenses/by-nc-sa/4.0/) This work is licensed under a [Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License](https://creativecommons.org/licenses/by-nc-sa/4.0/).