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Why Dentistry Is Separate from Medicine

theatlantic.com

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Re: Why Dentistry Is Separate from Medicine

#81

Post by mtdewcmu »

chimeracoder wrote: post #63
nerdponx wrote: post #48

Earlier quoted context omitted.

This is ass backwards to me Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part.

> Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part. When costs are easily predictable, that's actually a terrible case for an insurance model. Insurance is about smoothing risk, not making things cheaper. In fact, for services that are relatively chea…

I think the issue with dentistry is that half-assed dental treatment is affordable, you just pull the teeth; if you want decent work to save the teeth -- then it gets expensive.

Re: Why Dentistry Is Separate from Medicine

#82

Post by ghaff »

mtdewcmu wrote: post #79
chimeracoder wrote: post #67

Earlier quoted context omitted.

> 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.

I don't understand why you think dental EDIT: care is a market failure. There are dentists people can go to and get care. Pricing is mostly not affected by if you have insurance or not. (Most dentists will just charge you if their rates exceed what insurance pays.)

If you're arguing that "someone" ought to pay for dental care that's a different matter that doesn't really have anything to do with insurance per se.

ADDED: And one actually gets into cost discussions about things like crowns and alternative treatments with dentists. It actually seems like a good model of how healthcare spending should work. Yeah, I have insurance that pays some but thats orthogonal to the cost discussion I have with my dentist.

Re: Why Dentistry Is Separate from Medicine

#83

Post by maxerickson »

chimeracoder wrote: post #63
nerdponx wrote: post #48

Earlier quoted context omitted.

This is ass backwards to me Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part.

> Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part. When costs are easily predictable, that's actually a terrible case for an insurance model. Insurance is about smoothing risk, not making things cheaper. In fact, for services that are relatively chea…

One thing with dental care is that it is likely financially reasonable to charge someone less for insurance if they are receiving preventative care. A small filling costs much less than a root canal.

Re: Why Dentistry Is Separate from Medicine

#85

Post by ghaff »

mtdewcmu wrote: post #81
chimeracoder wrote: post #63

Earlier quoted context omitted.

> Preventative dental work is dirt cheap and corrective dental work is relatively rare, and costs rarely spiral out of control. That sounds like a much better deal to me, as an insurer, than insuring any other body part. When costs are easily predictable, that's actually a terrible case for an insurance model. Insurance is about smoothing risk, not making things cheaper. In fact, for services that are relatively chea…

I think the issue with dentistry is that half-assed dental treatment is affordable, you just pull the teeth; if you want decent work to save the teeth -- then it gets expensive.

Which is presumably one of the reasons why some more expensive dental treatments like crowns are only covered at 50% or so by most insurance. They're considered at least partly cosmetic.

Sometimes extractions make sense in any case, but they're always going to be cheaper than multi-visit restorations of various sorts.

Re: Why Dentistry Is Separate from Medicine

#86

Post by AnthonyMouse »

ghaff wrote: post #80
AnthonyMouse wrote: post #77

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. 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.

That's assuming there is a tax benefit. What does it do to the EITC? Does your state or spouse's employer or school have a dental program you get disqualified from if your employer offers coverage? Maybe there is a way for the employee to claim it as a deduction? The US tax code and welfare system is so convoluted that it's difficult to identify whether a given thing will actually save you money without consulting a tax attorney.

Re: Why Dentistry Is Separate from Medicine

#87

Post by ghaff »

PeterisP wrote: post #51
mtdewcmu wrote: post #35

The real question is not why is dentistry kept separate from medicine. The real question is why dental insurance is treated like a luxury, compared to regular health insurance. The problem is that so many people are unable to afford dentistry, because of poor or no coverage.

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…

>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 because of an extra middleman.

And your dealer would probably be happy to sell you an extended warranty or something else along these lines and pocket the nice margins.

Re: Why Dentistry Is Separate from Medicine

#88

Post by mtdewcmu »

ghaff wrote: post #82
mtdewcmu wrote: post #79

Earlier quoted context omitted.

>> 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.

I don't understand why you think dental EDIT: care is a market failure. There are dentists people can go to and get care. Pricing is mostly not affected by if you have insurance or not. (Most dentists will just charge you if their rates exceed what insurance pays.) If you're arguing that "someone" ought to pay for dental care that's a different matter that doesn't really have anything to do with insurance per se. ADD…

It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.

Re: Why Dentistry Is Separate from Medicine

#89

Post by madengr »

PeterisP wrote: post #51
mtdewcmu wrote: post #35

The real question is not why is dentistry kept separate from medicine. The real question is why dental insurance is treated like a luxury, compared to regular health insurance. The problem is that so many people are unable to afford dentistry, because of poor or no coverage.

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…

I work for Honeywell. They just dropped paying their share for dental insurance. It's now 100% employee paid, thus I dropped the insurance and just pay out of my HSA. The insurance makes no sense financially, short of having multiple teeth knocked out.

Re: Why Dentistry Is Separate from Medicine

#90

Post by madengr »

peteretep wrote: post #59
barking wrote: post #25

Earlier quoted context omitted.

Ophthalmologists are specialists just like any other medical specialist, e.g. a dermatologist. Does the fact that general practitioners refer people on to dermatologists mean that family doctors are not 'real doctors'? Sorry if that sounds aggressive, I am unfairly taking the inference from what you said that opticians are somehow 'fake'.

> Ophthalmologists Doctor > dermatologist Doctor > general practitioner Doctor > optician Not a doctor

You mean physician. An optometrist typically has a Doctor of Optometry degree. One can argue if that's really a Dr. (I'd say it more like an MS), but nonetheless they could be called Dr. They also write prescriptions for lenses.

An optician fits the glasses, which is more like the technician.

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