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Why Dentistry Is Separate from Medicine

theatlantic.com

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Re: Why Dentistry Is Separate from Medicine

#71

Post by AnthonyMouse »

morganvachon wrote: post #45
brianwawok wrote: post #43

Earlier quoted context omitted.

I think it is cost scale. Get cancer? That could be a million dollars in treatment. You need insurance. Get a bad tooth? Maybe 3k max to replace it with a bridge or similar. The idea is most people can scrouge up 3k but not a million bucks.

> The idea is most people can scrouge up 3k but not a million bucks. The reality is far from that, though. Roughly a third of the citizens of the US would have to go into debt to secure $3K on the spot, they don't just have that laying around in the bank. Doing so could easily cause a downward spiral where one would have to choose between basic necessities or moving back in with family for months or even years to pay…

> Roughly a third of the citizens of the US would have to go into debt to secure $3K on the spot, they don't just have that laying around in the bank.

That doesn't change the nature of the problem.

With catastrophic events, one person in 250 will incur a million dollar expense in a given year, so everyone pays four thousand dollars a year for insurance and that person gets covered.

With dentistry, one person in five will incur a $3000 expense in a given year, so insurance would have to be $600/year. It's completely useless. If you couldn't afford the loan payment then you couldn't afford the insurance.

Insurance only works for things rare enough that most people in the pool will never incur the expense. If the event is common then it isn't insurance, it's just a prepayment plan.

Insurance never saves money, it only pools risk.

Re: Why Dentistry Is Separate from Medicine

#72

Post by chimeracoder »

mivade wrote: post #53
autokad wrote: post #50

i'm very happy its under a separate umbrella. think of all the years of unnecessary education they'd pile on to dentistry and the bottle necks they would put up to raise the wages to MD level. currently it costs 150$ to show up 10 minutes early for an appointment to be seen 20 minutes late for an interaction that lasts 5 minutes. and then i say 'my knee also hurts' and they say you need to schedule another appointmen…

> think of all the years of unnecessary education they'd pile on to dentistry and the bottle necks they would put up to raise the wages to MD level. That seems more an indictment of the medical education system than the insurance system. There are already parallel medical education systems in the US (MD vs. DO, although there is little practical difference). Seeing either type of physician is treated equally by healt…

> MD vs. DO, although there is little practical difference). Seeing either type of physician is treated equally by health insurance

Uh, not exactly. MDs and DOs do receive different sorts of education, and insurance can distinguish between them.

Re: Why Dentistry Is Separate from Medicine

#73

Post by chimeracoder »

ferongr wrote: post #68
ekianjo wrote: post #57

Earlier quoted context omitted.

in japan you can completely bypass them if you just need corrective glasses. result: glasses are dirty cheap.

In Greece too. As long as you have the older prescription (basically a small form with the required information filed in) you can get new spectacles without having to visit the ophthalmologist. The prescription is not taken away In many cases, eyewear shops have ophthalmologists employed on site with all necessary equipment and they test you for free.

> As long as you have the older prescription (basically a small form with the required information filed in) you can get new spectacles without having to visit the ophthalmologist. The prescription is not taken away. In many cases, eyewear shops have ophthalmologists employed on site with all necessary equipment

This is true in the US too. (And the prescriptions must be transferable by law.)

Re: Why Dentistry Is Separate from Medicine

#74

Post by ghaff »

AnthonyMouse wrote: post #58
PeterisP wrote: post #51

Earlier quoted context omitted.

If you have a type of expense that's (a) unpredictable, and (b) rare, then it's a good fit for insurance. Car crashes are unpredictable and rare, so it makes sense to insure them. Regular car maintenance is predictable and tends to happen in (almost?) every insurance period, so it's not - some payment plan or bundling may be an option, but insurance makes no sense, it would only be more expensive than paying directly…

> If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't. And how is that anything useful anyway? It's not like dentistry is any cheaper when your employer pays for it. If anyth…

I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. This is somewhat mitigated by the fact that employees could just put money for routine teeth care into a flexible spending account. (That said, most bigger ticket dental items like crowns are typically only covered by about 50% anyway because they're often at least partially cosmetic.)

Re: Why Dentistry Is Separate from Medicine

#75

Post by mtdewcmu »

rs999gti wrote: post #61
mtdewcmu wrote: post #31

Earlier quoted context omitted.

I was thinking of pharmacists. They are sorta kinda doctorish (they even get Doctor of Pharmacy degrees), but not really. They are supposed to be consulted by doctors as the prime authority on medications, but this seems to rarely happen outside of hospitals. Doctors most likely think they know enough about the medications they prescribe to not need regular help. Oh, and what about podiatrists? Health care seems suff…

> podiatrists Podiatrists are doctors, they just have their own medical schools AKA podiatry school - https://en.wikipedia.org/wiki/Podiatric_medical_school Podiatrists are sometimes ridiculed for not being real doctors like dermatologists. However, to diabetics they are life savers.

By the same token, you could argue that dentists are also real. They are licensed and they can prescribe drugs and perform procedures independently.

My point was more to show that dentistry is not unique in being separate from the medical profession. There are a variety of health professions that have responsibility and esteem that aren't MDs.

Re: Why Dentistry Is Separate from Medicine

#76

Post by autokad »

Broken_Hippo wrote: post #54
autokad wrote: post #50

i'm very happy its under a separate umbrella. think of all the years of unnecessary education they'd pile on to dentistry and the bottle necks they would put up to raise the wages to MD level. currently it costs 150$ to show up 10 minutes early for an appointment to be seen 20 minutes late for an interaction that lasts 5 minutes. and then i say 'my knee also hurts' and they say you need to schedule another appointmen…

This isn't necessarily true. Most dentists won't even need additional education - after all, we are actually just trying to get what they do covered. It doesn't mean the system or education must change, and in practice it will be like going to a specialist without having to visit the GP first. You wouldn't complain to the gastric specialist that your knee hurts either. The bigger changes would be in health insurance…

once you bring dentistry under the medical insurance, i believe everything else bad in medicine follows.

dental insurance is already a lot more affordable, its just that people treat their dentist like an emergency intervention rather than maintenance.

that is solved through awareness, not trying to pull dentistry into the incredible blob

Re: Why Dentistry Is Separate from Medicine

#77

Post by AnthonyMouse »

ghaff wrote: post #74
AnthonyMouse wrote: post #58

Earlier quoted context omitted.

> If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't. And how is that anything useful anyway? It's not like dentistry is any cheaper when your employer pays for it. If anyth…

I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. This is somewhat mitigated by the fact that employees could just put money for routine teeth care into a flexible spending account. (That said, most bigger ticket dental items like crowns are typically only covered by about 50% anyway because they're often at…

> I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more.

That's just an example of bad policy, not a reason to encourage that as a solution to the problem. If buying dental insurance or dental services is tax deduction when paid by the employer but not the employee, fix your tax code.

Re: Why Dentistry Is Separate from Medicine

#78

Post by TheOtherHobbes »

cma wrote: post #44
pricechild wrote: post #22

Earlier quoted context omitted.

Only a few years ago most "NHS Dentists" were full. Just like that. No new patients. Tough. It's only relatively recently that you'll find yourself driving past one with "Now accepting NHS patients" on big banners outside.

When you say most do you mean 51% were full, or something more drastic than that? Wouldn't most having vacancies be inefficient?

Full as in "Yes, we're accepting patients, but the waiting list is two years, and we won't see you for an emergency until then."

I had a lot of NHS work done last year. I didn't pay much because I was used as a guinea pig by a couple of freshly qualified dentists who wanted to improve their skills before being promoted to private practice.

One dentist was good, one was kind of okay, I guess.

The deal wasn't explained. It was "And this is the NHS dentist you'll be seeing." Which is maybe not as ethical as it could be.

I've paid for private care in the past and it's never been significantly better. You get more choice of filling/crown material, but the actual work seems to be as good - or bad - as NHS work.

By far the best work was done for free by supervised students at an NHS teaching hospital in the 80s. Most of it has lasted for decades.

The issue with dentistry is possibly that there's no distinction between primary health care - the "have this tooth out or die of sepsis" kind - and purely cosmetic surgery, which is strictly optional.

There's also some overlap with products like implants, which improve looks but can also work better than fillings/crowns.

I can't think of any other branch of medicine which has the same tension between health and appearance.

Re: Why Dentistry Is Separate from Medicine

#79

Post by mtdewcmu »

chimeracoder wrote: post #67
AnthonyMouse wrote: post #58

Earlier quoted context omitted.

> If you want employer-funded healthcare to include dentistry, then that's not going to be solved by medical people but the employment market - industries where workers have market power (e.g. IT) will get such conditions, and industries where worker's don't have market power (e.g. fast food) won't. And how is that anything useful anyway? It's not like dentistry is any cheaper when your employer pays for it. If anyth…

> If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits. Yes, real insurance (like car insurance or renter's insurance) will always have an expected value that is negative - the expected sum of all future payouts must be less than the sum of all future premiums paid. So insuring against completely predictable events is never worth it unless someone else pa…

>> So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.

It's worth it if the government guarantees it. Dental insurance might not be a good business to be in, but nevertheless people need it. It's a market failure, and it needs government intervention.

Re: Why Dentistry Is Separate from Medicine

#80

Post by ghaff »

AnthonyMouse wrote: post #77
ghaff wrote: post #74

Earlier quoted context omitted.

I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. This is somewhat mitigated by the fact that employees could just put money for routine teeth care into a flexible spending account. (That said, most bigger ticket dental items like crowns are typically only covered by about 50% anyway because they're often at…

> I am not an accountant, but in the US, I'm guessing that there are tax advantages to offering employees dental insurance rather than just paying employees more. That's just an example of bad policy, not a reason to encourage that as a solution to the problem. If buying dental insurance or dental services is tax deduction when paid by the employer but not the employee, fix your tax code.

I don't actually disagree. But in the meantime I'll take the dental insurance and the tax benefit that comes with it.
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