Doctors and patients get burned by the world’s worst middleman.
In the first circle of Dante’s Hell, things aren’t so bad: The unbaptized and the virtuous pagans get to kick back, forever, with Homer and Ovid, watch Julius Caesar and Saladin do the limbo, etc. But things take a pretty sharp turn for the worse thereafter: Paris, Tristan, and Cleopatra get buffeted about by the winds of lust in the second circle, Cavalcante de’ Cavalcanti suffers a ghastly punishment for his heresy in the sixth, and soon enough you’ve got Satan himself gnawing on Brutus, Cassius, and Judas. But even with Virgil to guide him, Dante never looked into the little-known tenth circle of Hell, the joint headquarters of the federal health-care bureaucracies, i.e., Satan’s outhouse.
And if you think spending eternity submerged in a river of excrement sounds bad, try getting an appointment with a dermatologist. Dante had “Abandon Hope, All Ye Who Enter Here,” but we have “Please hold and your call will be answered in the order it was received.”
Researchers at JAMA Dermatology decided to do a little investigative journalism and cracked open the physicians’ directories for Medicare Advantage in twelve metropolitan areas. They invented a father with a suspicious itch, and started trying to make appointments. (Reuters provides an excellent summary of their findings here.) With 4,754 dermatologists to choose from, you’d think that would be pretty easy — and it’s lucky for you that there’s not a level of Hell for the naïve.
That population of 4,754 dermatologists turns out to have been decimated — about a tenth of them had moved on to one of the three sections of The Divine Comedy, or, short of that, had retired or were no longer practicing medicine. But the headcount has to be reduced further, and drastically: About half of the physicians were double-listed; unsurprisingly, the federal government is a much more attentive bookkeeper when it comes to your tax liabilities than it is when it comes to your health care. Another 18 percent were simply unreachable, and 9 percent were not taking new patients. Of those 4,754 theoretical dermatologists, there turned out to be 1,266 actual dermatologists still among the living, practicing medicine, and willing to make an appointment. But not for everybody: In some cases, there was not one dermatologist willing to see patients with certain Medicare Advantage plans. That’s what happens when you put politicians in charge of health care: You get a great deal on an insurance policy that no one accepts.