Cato is shocked, shocked! To find wait times for care in the US.

The NYT reports on the differing wait times between high-cost cosmetic procedures in dermatology, and low-cost potentially life-saving screenings for melanoma and other skin cancers.

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.

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.

What’s then great is to see the “market solves all problems” types at Cato try to wrap their heads around this astonishing instance in which the market doesn’t provide good for all and cute dancing little elves.

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

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 to Peter and me.

Oh yeah, it must be the influence of medicare to blame! If it weren’t for the bad influence of those dirty socialists the private insurers would be reimbursing preventative care with gold dubloons!

Or, maybe, just maybe, the market doesn’t provide goods equally between between socioeconomic strata. Maybe, just maybe, people who can afford 600 dollar botox injections receive faster more prompt care than the average schmo looking to figure out what some growth is. Maybe this is a sign that the profit-motive in medicine leads to shortages of care for more important needs and poorer patients as the profitable low-hanging fruit will always be more appealing than dealing with insurance companies and the average peons off the street who may not be able to pay their medical bills.

Cato can blame “markets dominated by third-party payment and rigid prices”, and there is some truth to that, but the bigger problem is that fighting with insurance companies for reimbursement with their “mommy may I” and 10% routine rejection policies is a hassle. It’s just easier to take rich people who want botox injected into their face than practice the routine preventative care that is critical for keeping healthcare costs down. It’s a sign that our medical priorities are screwed up, the private insurance based system is not providing adequate care, and the right type of medicine is being discouraged. It’s also ironic that as much as Cato complains about wait times in Canada (wait times for “emergency” cataract surgery – oh noes!), they aren’t nearly as quick to judge a market systems critical flaws as those of a socialized one.