As an entrepreneur still trying to make it I don’t the extra cash for insurance right now so I just pushed it off thinking it would take care of itself. -
...and that's why i can't support candidates who want to repeal universal healthcare in the US, most of whom are Republicans, and ironically, in their opposition to reasonable universal healthcare are adopting a policy that is incredibly anti-small-business.
Individual dental plans typically aren't available. Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care.
So even with insurance, he'd be paying 50% (and probably could negotiate 20% off with a cash payment without insurance, so insurance only costs 30% less). Did he have 50%, or would he still have put it off due to the expense. Is asking him to pay for it a "failing" of society? If so, consider the cost of dental insurance that provides 100% coverage for procedures that are generally preventable.
Insurance is about math. Because truly catastrophic dental care is rare, dental self-insurance is generally a matter of cash management, and you usually can come out ahead, even with an issue like this during a year.
Context: I am an entrepreneur "still trying to make it". I have a wife and 2 kids. We don't have some magic source of easy income. Planning for the cost of insurance was part of planning to start a company. So was planning to self-insure dental. It is possible. I don't understand why any of this planning should be anyone's responsibility other than my own. I don't believe I should be asking someone else to pay for my insurance as some sort of societal debt, and I wish the feds would quit adding mandatory coverages and regulatory overhead that makes buying insurance more expensive.
If either party REALLY cared about small business, they would have taken the simple, obvious step of making individually purchased health insurance tax-deductible long ago. But that didn't fit their agenda.
"Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care."
Wait, what? It's true that under most dental coverage you pay a percentage (and not a flat co-pay) on oral surgery, but for the life of me, I don't understand the idea that the need for wisdom tooth extraction is ever preventable by proper dental care. No amount of brushing and flossing is going to prevent your body from throwing extra teeth in your mouth in your late 20s.
If anything, proper dental care means none of your teeth will have fallen out, so when your wisdom teeth come in they have nowhere to go and get impacted and then decayed and then infected.
I said "not always". Although it seems possible that scheduled wisdom tooth extraction may have been possible with proper care, regular x-rays, etc, that's not really the point.
In my recollection, scheduled wisdom tooth extraction has usually been on the same 50% co-pay as emergency wisdom tooth extraction. And I don't think the "emergency" part has the cost implications in dental that it does in other medical realms.
Neither is pleasant, but the cost would probably be the same either way. I don't try to justify the tiering of the co-pay, but recognize that moving it down to the 20% co-pay range just means the actuaries factor that change into everyone's premium.
You said "typically (not always)" and I say pretty close to never.
I don't try to justify the tiering of the co-pay
You said the co-pay was tiered "because such procedures are typically (not always) preventable" (emphasis mine).
(i'm note 100% sure that by 'tiered' you mean that you pay 50% for this instead of the flat or 0 co-pay most dental coverage has for checkups and the like)
Sure, you can micro-parse the language, and yes, I mean it's at the 50% co-pay or whatever.
If I were trying to explain the rationale in this case, I'd theorize it's because this is typically something that happens once in a lifetime (if at all). I'd expect once one wisdom tooth gets cranky, they'd yank the rest at the same time. So, in this case, the thought would be that people partially pay for it when it happens rather than making everyone in the insurance pool pay for that risk every month, especially people with no wisdom teeth.
But I am not an actuary or insurer, so I don't know for sure.
It's not always a 50% co-pay. That will vary by state and by plan. I have pretty cheap & awful dental insurance, but wisdom teeth extraction was 100% covered. I think my only cost was the copay for anesthesia.
Dental insurance is pretty cheap -- there are a limited number of high-dollar procedures that happen infrequently. Plus, major costs like anesthesia are usually part of medical coverage. So while the insurance pool is more likely to pay for a wisdom extraction for many folks between 18 and 30, that's a one time event.
Medical insurance, on the other hand, needs to cover a broad array of overpriced procedures with nearly unlimited liability. I had a back surgery that cost my insurance company about $75k. The recent birth of my child cost nearly $25k!
some people dont have space for wisdom teeth, and in such cases they need to be removed - whether it can bedone simply with some freezing or some more complex surgery depends..... but uf you dont haveenoughspace, as many dont, they gotta come out.
I'd go with a business rational over the theory of distributive just over lifespans. It's an adverse-selection problem. Wisdom-tooth extraction is usually not an emergency (Nick's case excepted!)-- they have to come out sooner or later, but often you've got some time. And it's a big cost compared to most dental work. If the insurer covered all or most of it, you'd have people signing up for dental coverage, getting their teeth pulled, and dropping out.
Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit. Case in point, I (25-year old guy) had a wisdom tooth which grew sideways (into the next tooth) and _would_ have destroyed the next tooth and caused an infection like the one linked in the article. I have a second one which might do the same.
These things are not preventable, you were just born lucky. Remember, humans didn't usually live to become 50 years old.
> Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit.
Exactly this. I had something similar (identical?): A horizontal impaction of my bottom right molar. Had I left it longer, it would've destroyed the roots to the molar in front of it, and I would've lost that tooth, too.
I suspect it's largely genetic. My mum has all her wisdom teeth, and she's never had an issue; my father had all of his removed because they didn't come in straight. My situation played out identically to his. Hence, I don't believe that simply taking pristine care of the teeth will magically help--if they don't erupt from the gums properly or come in crooked, there isn't much else that can be done save an extraction if they're problematic. In many cases, you're better off having them removed to prevent issues precisely like this one.
I'm missing two upper teeth [0], which resulted in my having enough room in my mouth for my upper wisdom teeth to fit comfortably. It's evidently of genetic origin in my case, as I have relatives who are missing the same teeth, which I think from that source are called the upper lateral incisors. Were I not missing those teeth I expect I'd have needed the upper wisdom teeth removed to make room.
(On a tangent, there's a great article [1] about how bulldogs have been bread to have massive jaws and a very short face and that results in all kinds of breathing difficulties.)
Interesting. I know of at least two other people with that condition who were missing a number of adult teeth that never came in. Though, I think their example is somewhat more extreme (and according to Wikipedia, I guess it would be classified as oligodontia), because at least one of them required extensive dental surgery for implants since they quite literally lacked 6+ (maybe more?) teeth.
> (On a tangent, there's a great article [1] about how bulldogs have been bread to have massive jaws and a very short face and that results in all kinds of breathing difficulties.)
I bet that applies to persian cats, too, since they're bred with extensively concave faces (something that seems cruel, IMO).
Very interesting reply--thanks for sharing that, because I had completely forgotten that one of my friends has a similar condition. Can't believe I completely forgot he had implantation done, too...
"Remember, humans didn't usually live to become 50 years old."
This. Also, humans used to lose a lot of teeth. Modern dental hygiene is a very recent development within the ~200,000 year span of H. sapiens sapiens. Throughout most of human history, wisdom teeth served as reserves, of a sort, to fill in what were likely to have been more than a few gaps.
These days, proper dental hygiene means you've more likely than not been able to keep all of your adult teeth, ergo, it's highly likely than your wisdom teeth will become impacted. The assertion that proper dental care will prevent wisdom tooth impaction is ludicrous.
It is true, however, that extraction of wisdom teeth can be managed to an extent. Almost everyone gets them at some point, and impaction is very common, and all of this is well known. So a proper dental regimen should include x-rays to search for wisdom teeth well before they become problematic. If this is what the OP intended to say, then fine. But his phrasing makes it sound as if he implied that proper brushing and flossing will obviate the need for wisdom tooth removal. Last I checked, brushing and flossing do not alter the shape of one's jaw.
To defend myself here (a day later), I was not assigning the causality in that direction. The "Because I took care of them" clause goes with the "I get to keep them", as in "I made sure to clean them and not let them get cavities, so there aren't any problems with them staying around". I thought the English was clear enough as I wrote it, but I guess parse errors are more common than I thought.
"obvious step of making individually purchased health insurance tax-deductible long ago."
I deduct my health insurance premiums as tax-deductible.
I'd like disability insurance to be deductible too. Seems that's kind of a no-brainer, as I'd be able to rely on disability insurance rather than hitting up social security if I didn't need it.
This is probably true for dental, for a lot of reasons, including the routinization of dental care, the degree to which dental expenses are preventable, the fact that fewer people have dental insurance than health insurance (and so the market for dental care is less distorted), and the extent to which dental care can be cosmetic.
The same isn't true of health care. The health care market is totally distorted by insurers, who collude with providers to set prices. Services fall into two buckets: routine "checkup" type stuff that costs so little it's not worth arguing about, and hospital/specialist services for which there is no pricing transparency and which, purchased by anyone other than an insurance company, is catastrophically expensive.
It is perfectly reasonable to advocate for single-payer health care even if one believes firmly in moral hazard. There are other interventions one could advocate for instead. But any way you slice it, the "market" we currently have is busted.
Health also has significant variance in outcomes, much more than the variance in dental costs, so it makes sense to pool risk. However, the fact that events aren't uncorrelated like a lightning strike makes it hard to deal with as an "insurance", the usual risk-pooling strategy, because in many cases the event has already happened, so no sane insurer would insure against it (how is it insurance if it has an 100% chance of occurring?).
For example, an American friend of mine has a congenital heart defect which will over his lifetime cost probably $1m or so; I had better luck and was not born with one. It seems sort of problematic imo that this sort of thing isn't risk-pooled across the population. It's already bad enough that he has to have surgeries/etc. for it, but due to our health system it also impacts areas of his life that shouldn't be affected, like choice of career. For example, he can never start a startup or do freelance/consulting work, because he wouldn't be able to buy individual health insurance; so he has to work at a large company with a good group-health plan, and can never be unemployed for longer than the 18-month COBRA limit.
Sure, people can't be the same, but I see paying for major healthcare problems as just one of the basic "civilized society" baselines. I mean, in most of those other cases you have other choices: can't be an air force pilot, do something else. And we do make some baseline effort to ensure that you have some ability to choose a career, by providing free public education. But if you have a heart that doesn't work without medical treatment, you don't have an alternative to "get medical treatment".
I guess I don't at all mind paying an equal share of those kinds of expenses, either. To me, not having heart defects, leukemia, down syndrome, or any of a number of things I might've had is its own reward, because my quality of life is better and I don't have to get surgeries and whatnot. I don't see a need to also come out financially ahead of those who had the misfortune to need the surgeries, so I win the health lottery twice and they lose it twice.
The moral-hazard problem also seems pretty weak, at least when it comes to major things like surgeries; I doubt there are many people who would've avoided getting cancer if they had to pay for it, but if it was free decided hey what the heck (that is, the suckiness of major illnesses is already a bigger disincentive than the expense of treatment). Moral hazard might come into it more with things like overprescription of antibiotics for routine/minor illnesses.
Sorry, deleted not realizing you had replied. For reference:
It's not Kosher, but the thing that always pops into my mind is- you've got the body you were given. Are we now also in the business of equity across our mortal coils?
Plenty of people can never be air force pilots; they need glasses, or are too tall/short, etc. The same goes for athletes, and so on.
There was single payer before the tax code subsidy for insurance came along. It was called "cash".
The subsidy is responsible for a lot of distortion. It has separated cost and benefit in the minds of employees.
And it hands more of a subsidy to people who make more money. Taking insurance from your employer is a bad deal if you don't make enough. Which is why many employers of lower paying jobs don't offer it.
I don't disagree with you, but I wonder if this situation would be covered by the law as AFAIK dental coverage isn't part of the plan. It boggles my mind that medical conditions that arise your teeth and gums (which, as this anecdote illustrates, are fully capable of killing you) are treated as an entirely different thing as diseases that happen elsewhere in the body.
That sounds just silly. Here in Finland, we can actually choose to either use free public dental care, or go to a more expensive private doctor and pay the difference.
Dental care is essential. Even if you don't have pain, constant inflammation can cause you all sorts of problems.
Oddly enough, here in Denmark, which otherwise has very strong social services, dentists for adults aren't covered, though their cost is partly subsidized (dental care for children is covered).
Same in Sweden. There's even been some scandals about local governments refusing to pay for (more expensive) treatments for people who cannot afford them and are on welfare, instead having their teeth pulled out. Rather sad for a country with a 45-50% total tax burden. :/
Yeah, I always thought it was odd that I had to get a special insurance for dental work. This is supposed to be a socialist land of milk & honey, not cold-hearted America :p
Sweden used to be all about reaping the benefits of both capitalism and socialism, but now our gov't seems to take a perverse joy in making it a "worst of both worlds" type of country.
I would be curious to know what countries today offer what Sweden used to offer. New Zeeland? Canada? Denmark?
Same in New Zealand. Free for under 18, but after that you have to pay. However, if you have an accident and need medical care, it's covered under the government. If it's due to negligence, then, well, you're responsible.
When I was a child (8 or 9, can't remember) I chipped my front tooth on a trampoline. All my checkups, x-rays, caps, etc., and eventually a root canal and crown were covered, even 10 years afterwards.
Same goes for america if you are on medicaid. They only cover up to 21 years and then they drop you, as if dentist work is merely cosmetic. And even with private insurance, across the board, only 50% is covered, so that root canal is still going to cost you about $750 out of pocket. It's a total joke.
Healthcare, at least where I'm from, doesn't cover preventative dentistry, but it does include anything life threatening which includes the situation from the article. I would sincerely hope the US system would behave similarly.
US health insurance tends to distinguish based on the location whether it's "dental" or "medical": if an infection sends you to the hospital, then it's medical, but if you go to the dentist to get it fixed, then it's dental. Typically the latter wouldn't get covered by health insurance regardless of severity.
There are some miscellaneous oddities; for example, if you visit a dentist and have antibiotics prescribed, typically the visit won't be covered (it's a dentist so counts as dental), but the antibiotics will be covered (they're a medical prescription).
The problem is, the average person can't tell whether a toothache is a minor, non-covered issue, or a life-threatening problem that would be eligible for coverage - without going to see a dentist out-of-pocket, that is.
That's not too hard. Having a minor or even a somewhat annoying toothache for a day won't kill you. As can be seen in the article, such infections don't develop overnight. Just wait a few days, and if you still need to use ibuprofen or what have you to make it go away, then you can be sure you need to go visit a dentist. Making it a habit to use painkillers to deal with toothache = bad.
most people with impacted, rotting, painful wisdom teeth know damn well they need to have it taken out. some just decide not to because nobody likes the dentist and they think it will just go away.
Truth be told, in most cases, it will 'just go away'. (Read: said tooth will fall out, and it will HURT.) Though it's better not to take these kind of chances.
Health insurance doesn't normally cover dental work. Dental plans are generally a separate offering, and typically aren't a good deal for younger people who take decent care of their teeth. Even Medicare doesn't pay for dental work.
Indeed. I avoided dental work a while back when I didn't have dental insurance. Instead of getting a cavity filled for $150, I ended up needing a $1000 root canal. But even then, not that expensive. Dental procedures are generally simpler than medical procedures, and cost less as a result.
(Getting three wisdom teeth removed did not appear to cost that much either, but my insurance paid for that.)
What bothers me is that many of the so-called dental "insurance" plans I've seen in the U.S. have quite low caps. Essentially, they work out more as a kind of "payment plan" against average expenses when measured over multiple years.
I'd rather pay for those, myself, but have "real" dental insurance for the quite expensive, unexpected stuff. Infections. Complications from non-routine extractions (particularly notable with some wisdom tooth extractions). Etc. Things where a $1000 or $2500 cap may hardly make a dent in the final expense.
When I was looking at individual dental plans (actually, "group plans" from the ACM or IEEE), it seemed to me that it was basically the cost of two dental visits amortized out over 12 months, with a small discount on other procedures.
With a "real" group plan, the only things I've had to pay was a $300 deductible on the wisdom teeth removal and $25 for a flouride treatment that insurance doesn't cover. (Presumably because most adults don't have braces.)
How much exactly does health insurance cost now in the US?
In Germany, I have to pay 65 Euros (87 Dollars) for health insurance as a university student if I earn more than ~400 Euros a month. It's not free here either, it's just mandatory.
I pay $370/month to cover my wife and I, and that's on a company-subsidized plan. The actual cost is at least twice that much on a group plan. If you try to buy insurance as an individual, the cost is even higher. And my plan requires me to spend $10-$75 for prescription medicine, and doesn't cover more than basic care from eye doctors or dentists.
I am 27, so my case might not apply to older people. However, for me in the US, I pay approximately $85/month for a high deductible plan as an individual. I am stuck with the first $5,000/year of medical expenses, of which in most years I only spend around $100-$200 for a checkup and labs, but I am covered 100% after that.
However, I can put $3,100/year into a HSA account. I immediately get to deduct the amount I put in from my taxes (which for someone with an income just about pays for the insurance), and I can grow it in the HSA and not pay any taxes on withdrawal if I use it for medical expenses (works kind of like a super IRA).
Is your employer covering part of the cost? My insurance for just myself is 70-80 a month, while my employer covers another 250 a month. If I had a full family plan it would be 250 a month for me and 750 for the company. This is for a relatively standard 2000(individual)/4000(family) high deductible plan.
I wouldn't think our different deductibles would save you that much money, but perhaps.
No, I don't have an employer covering my cost. The full cost for my $5000 high deductible individual plan is $85/month.
Perhaps the difference is that my plan was purchased in Illinois (Blue Cross Blue Shield of Illinois). I know state mandates can significantly change the cost of insurance.
I pay about $1500/month for a family of four. Admittedly this is an HMO group plan in NY as opposed to a high deductible plan since we have some pre-existing conditions that preclude a non-group plan.
Certain segments of the USA have universal health care. As part of the treaties one of these groups is Native Americans through IHS. Google "don't get sick after June" for how the USA approaches universal health care. I support any candidate that would repeal what was passed and try to come up with something different. If they cannot get it right for 7 million then they won't for the rest.
A story that ties both together. My dad was visiting me. He was going to go golfing with my brother, but had too painful of a headache and was just going to lay down then drive the 7 hours home. It was so painful that we convinced him to go to a hospital. I just happened to pick one that had a neurologist in emergency. He was bleeding from the brain because of poorly prescribed blood pressure meds. The doctor in the ER was not happy. He was in surgery that day and took a week in the hospital.
> If they cannot get it right for 7 million then they won't for the rest.
That's a pretty bullshit example. Native American services are an entirely different planet within the government.* The lost billions of dollars in indian trust funds, etc. Pretty much every service for native Americans is monumentally dysfunctional, yet the equivalent services for non-Indians often work quite adequately.
*) This state of affairs is the product of a lack of political will to do better (who cares about the poorest constituency in the country?) and certain Constitutional insulation from the rest of the government.
I don't think it is a "bullshit" example. Past performance of an entity tends to predicate future performance. The equivalent service is also provided to our veterans. The VA is also a failure. Just because white people will be serviced doesn't mean it will be any better. The legislation sets up the same pattern of control. The currently passed bill fits all of the fiscal and regulatory issues of IHS.
I would love to see the statistical change on that. They did a lot of damage to vets around here (miss diagnosing, etc). The hospitals they own are not great and need some serious changes. Never mind the fun policy of just moving problem staff.
Exactly. Nothing about Obamacare absolves him of his responsibility to purchase health insurance; it only adds a penalty if he doesn't (and tries to make it cheaper/easier to do so if he does). You still have the responsibility to purchase/maintain it.
As someone who has had an infection requiring dental care: dental surgery is covered by the Canadian provinces if it is medically necessary. On the other hand, preventative care and cosmetic surgeries are not covered.
They have dental setups in the hospitals here for emergencies but generally it's not taken seriously enough. Poor dental care can have a tremendous impact on a persons physical and mental health.
As someone form a country with a working, good, universal health care system, the notion that many Americans have that it somehow can't work in reality is very puzzling to me. How can that be true when it plainly does work in many places?
The argument that a private insurance based system could be better, fairer, or more efficient can be made (although not if you hold up the current US system as a positive example...), but any argument that it's the only thing
that will work is frankly ludicrous.
Healthcare in the US, even in its incredibly broken state, still "does work". We can compare anecdotes all day long, but that tells us nothing, anecdotes are not data.
I believe it's generally known to be true that health care in the UK, where I live now (I have also lived in the USA in the past), whether measured by % of GDP or by monetary cost, is much cheaper per capita than health care in the USA[1]. Life expectancy, probably a good measure of the efficacy of a health care system, is very close, perhaps with the UK having a small lead, if anything[2].
If we were to allow anecdotes, I'd also say (and I find this to be a good thing) that people in the UK don't avoid going to the dentist or doctor because it's too expensive. I'm sure that there must be studies that show this to be true.
Even if we're not allowing the anecdotal argument, however, if you're prepared to say that the system in the USA 'does work', you're surely prepared to say that the British system also works? Personally, I have a hard time not believing that, since it seems to produce comparable, if not better outcomes, for less cost, it's the better of the two systems.
Note that I'm /not/ arguing at all that a private health insurance system could not be devised that also worked as well - perhaps better. I'm also not arguing that any public system will be perfect. To argue that a public system /can't work/ though is, as I said, ludicrous.
Until we have a cure for the metabolic syndrome, I'd say that comparison of health care quality by life expectancy doesn't actually do what you think it does. America is incredibly obese, and this is a lifestyle choice that makes comparisons of the quality of care quite difficult.
I wouldn't even try to make the argument that public healthcare doesn't work. Comparing across systems and cultures (again, obese vs the rest of the world) is tough to do well. I was thinking perhaps some measure of in-hospital mortality would be useful, but even that would be confounded. Perhaps the Massachusetts model might work for in-US comparison to other states, but MA is not really comparable to single payer systems in the rest of the world.
It's a really interesting topic and I wish I weren't at work so I could brainstorm more with you about how to get a clean comparison.
It is a talking point from our country's politicians (who already have what would be offered under a real universal healthcare bill) who are in the pocket of private insurance companies, big pharma, and the like.
Call me a cynic if you like, but that is the only real argument I can think of. There is no data to back the claim up, only anecdotes about what it's like in other countries.
The data points to universal healthcare being better.
Healthcare is a scarce resource but what you say isn't all that universal healthcare provides. All healthcare systems must ration care. The goal is to ration care in the most ethical/moral way. The present system in the U.S. rationalizes care in a more unethical way that Finland and other similar healthcare systems.
This sort of hyper-simplistic modeling of real world problems is a pretty common trait among real academics, not just HN posters. In my own field of interest (spectrum management) the papers written by ostensibly reputable people are shockingly bad in their reductionist thinking and plain glossing-over of important caveats and assumptions in the applied theories.
If healthcare is an inelastic resource, the private sector won't make any more if you throw more money at it, and will just re-allocate it to those who can pay the most.
Scarce doesn't mean inelastic and health care -- especially basic one including antibiotics, vaccines, etc. -- is not inelastic, you can get more, as much as you like, really, if you divert resources from other pursuits.
The only way in which you're correct is that the supply of skilled practitioners (doctors, nurses, etc.) may well be inelastic, in that only so many of them will be born in a given timeframe and it requires a certain length of time to take a potentially good practitioner all the way up to actually being a good practitioner.
...and that's why i can't support candidates who want to repeal universal healthcare in the US, most of whom are Republicans, and ironically, in their opposition to reasonable universal healthcare are adopting a policy that is incredibly anti-small-business.