Basal-cell cancer.

Dermatologists  seem particularly up in arms about the narrowing of insurance contracts that have hit them and other specialists.

Brett Coldiron, M.D.,  president of the American Academy of Dermatology, says, reports Dermatology Times, that cuts to Medicare Advantage plans  caused insurers to eliminate their most expensive patients by eliminating the doctors who treat them from their network. ”Despite the fact their government reimbursement has declined from 114 percent to 104 percent of fee for service Medicare, the overall profit margin of insurers has increased.”

“In the long run, they will not save money,” he said. “They are de-listing physicians for treating the sickest patients. Delayed care means greater risk of mortality and more expensive care later on. What does it cost to treat someone with metastatic melanoma [compared to melanoma that has not metastasized]?”

Dermatology Times reports: “One of the distressing realities of this de-listing phenomenon is that patients who will be most affected are retirees, typically over 65 years of age, who have been making Medicare contributions throughout their working years, according to Dr. Coldiron.”

This last  remark is rather misleading. It’s common to say that since people paid into Medicare and Social Security in their working years that they have more than paid for what they get from services later in life. But because of increased longevity and the world’s most expensive medical care, most older people take out considerably more than they pay in, helping to intensify the nation’s long-term fiscal challenge.