8 ms·

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 h

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.

brianwawok 10y ago
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.
- nerdponx 10y ago
  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.
  - maxerickson 10y ago
    Preventative care isn't really insurable though.
  - chimeracoder 10y ago
    > 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 cheap and predictable, insuring against those events will always be more expensive than paying for them out of pocket, because of the additional overhead. Financially, the expected value of insurance is negative (the sum of all expected payouts is less than the sum of all future premiums). The reason it's valuable is because it reduces the variance in the month-to-month payments, which is a useful product for some people.
    - mtdewcmu 10y ago
      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.
      - ghaff 10y ago
        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.
    - maxerickson 10y ago
      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.
  - deleted 10y ago
    [deleted]
- morganvachon 10y ago
  > 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 back the debt (I know because I've been there). Hell, our household income is nearly $70k and while we do have enough in savings to cover such an emergency, it would still be painful and it would take us months to recover the money. Thankfully we both work for local government and have decent dental coverage, but it's a far cry from the much better health insurance we enjoy. Also, the idea that major dental surgery is "just" $3K is amusing. My bill for removing my wisdom teeth came to nearly $12K, of which my insurance paid all but $800 thankfully. That wasn't even the total cost either; I developed a severe infection and when I called my dental surgeon he told me to go to the emergency room (another $1200) to have it drained and get an antibiotic prescribed. The emergency room gave me the antibiotic but told me to go to the dental surgeon for anything else. It's a total clusterfuck.
  - sjwright 10y ago
    > My bill for removing my wisdom teeth came to nearly $12K Seriously? You could fly to Thailand or central Europe and get your dental work performed there for a fraction of the price. You could probably fly business class, stay at a swanky hotel, and absorb the loss of two weeks work and still come out ahead. I'm serious. Dental tourism is a thing. I was an accidental dental tourist a few years ago while travelling around Europe. I had just arrived in Budapest, Hungary when a tooth I knew required root canal suddenly started hurting intensely. Wife found a local dentist, booked me in, the procedure was done over a couple of sessions and the total cost came in well under $1k AUD. (Your bill seems excessive even by affluent Australian standards. I had four wisdom teeth removed – one of them impacted, requiring a dental surgeon – and the total cost was under $3k AUD at my local dentist. I bet it only "cost" $12k because it was covered by insurance rather than priced by the free market.)
    - chimeracoder 10y ago
- nervousvarun 10y ago
  That may be true as to why the insurance is separated, but unfortunately the idea that most people can scrounge up 3K is not accurate (at least in the U.S.). Source: http://www.usatoday.com/story/money/personalfinance/2016/10/09/savings-study/91083712/ http://www.usatoday.com/story/money/personalfinance/2016/10/...
  - brianwawok 10y ago
    Except that if you can't afford 3k, you also can't afford $600 a year for dental insurance.
PeterisP 10y ago
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 because of an extra middleman. Getting a broken leg or cancer is unpredictable (there are individual risk factors, but they are just as relevant for car crashes) and rare, so it makes sense to insure them. Dental care, on the other hand is common and regular - e.g. someone who didn't have coverage for broken leg or cancer most likely won't get a broken leg or cancer in the next year, but all the people who have been unable to afford dentistry generally almost all will need dentistry in the next year. 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. If you are unable to afford dentistry, then you'd be unable to afford the insurance price hike. It's not a problem of insurance as such, it's a problem of who pays for healthcare of poor people. USA has a weird historical artifact in that in the last >100 years insurance has become almost a synonym for employer-funded healthcare payment plans, not as real insurance. 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. Also, this can't solve the manner of dentistry for unemployed or underemployed people who don't get employer-funded insurance and thus a dentistry-included insurance would be as expensive or more than just paying for a dentist.
- AnthonyMouse 10y ago
  > 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 anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits. This is one of the reasons costs have spiraled out of control in the US healthcare market. If you need money for dentistry, ask your employer for a raise, not dental insurance.
BecuzYoullLive8 10y ago
Because our culture does not allow for providing a decent quality of life to everyone. I grew up poor, in one of the reddest of red states. I've been party to literally dozens of arguments, family, friends, coworkers, in the grocery store between randos, didn't matter who... the local cultural meme is: "You don't need teeth/glasses/asthma meds/whatever to live.". "Be glad you're not dead." is usually what follows. Poor, broken, but "alive". It isn't generally available to people with no money, so they build an emotional avoidance mechanism. A "hard living" mentality. Stoicism run amok. Politicians and neo-liberal economic policy take advantage of this. The experience may be subhuman in the figurative sense, but in a literal sense "you'll live."
rebootthesystem 10y ago
This is what you should do: Fire-up Excel and develop a financial model for providing dental insurance to a million people. On another tab, develop a financial model for providing mid-range health insurance to a million people. Finally, develop a financial model for providing automobile insurance to a million people. This will answer all your questions.
- rcthompson 10y ago
  Perhaps you'd like to enlighten those of us who are not experts in developing financial models for insurance scenarios?
  - chillacy 10y ago
    I know nothing about insurance, but treating this like one of those crappy interview questions, I'd say you multiply the probability of an incident with the cost of that incident times 1 million people, and that's your expected cost per year. Then you look at how much you charge each person and see if they're willing to pay. Probably as someone else mentioned, dental insurance is expensive because even though routine dental work is cheaper than getting cancer / breaking a bone, it happens 100% of the time.
  - rebootthesystem 10y ago
    I generally assume the HN audience to be composed of entrepreneurs or would-be entrepreneurs. Understanding finance and forecasting is a very important skill. The math is very, very simple. It's a matter of breaking down a business into costs and income to calculate profits. Again, simple math. All businesses, from a local coffee shop to a multinational share a simple equation that can be summarized through "EBITDA" analysis: https://goo.gl/A5nGML https://goo.gl/A5nGML You could start with expenses. I won't develop a comprehensive model here but here's a small list of what could cost an insurance company money. - Average number of claims per client per year - Average cost of claims - Regulatory compliance costs - Administration costs - Structural costs (buildings, desks, computers, cars, phones, etc.) - Cost of sales - Personnel costs (salaries, health insurance, benefits, taxes, HR, etc.) Spending some time on Google would reveal lots more detail on how to create a model on the expense side. If you can find a publicly traded insurance company their SEC filings would contain lots of useful information on cost drivers in that industry. I would definitely look for these filings if available. Next do income. Simple version: How many clients? How much do they pay on average? Complex: You need to divide clients into layers with different risk profiles. Each risk profile is likely to have to pay different premiums, etc. This connects with the cost side of the equation. I listed average cost of claims above, this isn't likely to be a realistic cost model. It might be OK for a quick first stab but you really need to model cost of claims in tiers with some relationship to statistical risk, etc. This requires some thought. Google, again, could be your friend here. In some ways, to talk in programming terms, you almost want to create a class to represent an individual client (with all the relevant variables) and then instantiate a million of them by using realistic distribution criteria to decide how these variables, well, vary. For example: Out of a million people, in any given year: What's the likelihood of a non-fatal heart attack? What's the likelihood of broken bones? What's the likelihood of hospitalization? You then have to attach costs to these events. You would then have to add a matrix of plans with different coverage structures, deductibles, etc. These plans will interact with the above to generate actual costs. Some people will have very low premiums but huge deductibles and light coverage. Others will opt for very higher premiums for more coverage and still have a deductibles structure. Google can provide ideas on what's out there. This can get very, very complicated. The simple version can give someone a basic understanding of what's at play. Bottom line, there's a reason for which comprehensive dental insurance isn't commonplace and this kind of analysis reveals it. To those of us used to the financial analysis of businesses the answer to this question is clear. I think it is important for people to try and understand how money works. A lot of the issues out there boil down to the masses not having this understanding. Every day politicians promise things that are firmly rooted in fantasy, a fantasy that is easily revealed with a quick dive into a spreadsheet. This is a huge problem.
drcnyu555 10y ago
Dentist here , I agree that many people can't afford desired treatment. It's common occurrence in a Dental office. Having the insurance still makes one liable for deductible ( entry money to seek any treatment ) , co payments and other hidden costs . That's how the system is designed.
fav_collector 10y ago
Dental insurance isn't even really insurance so it isn't comparable to medical insurance since there are no out of pocket maximums and the maximum benefit is pathetically low. It's basically a dental care/maintenance subscription and if you need any major work, you're going to pay $$$.

brianwawok 10y ago

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.

nerdponx 10y ago
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.
- maxerickson 10y ago
  Preventative care isn't really insurable though.
- chimeracoder 10y ago
  > 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 cheap and predictable, insuring against those events will always be more expensive than paying for them out of pocket, because of the additional overhead. Financially, the expected value of insurance is negative (the sum of all expected payouts is less than the sum of all future premiums). The reason it's valuable is because it reduces the variance in the month-to-month payments, which is a useful product for some people.
  - mtdewcmu 10y ago
    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.
    - ghaff 10y ago
      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.
  - maxerickson 10y ago
    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.
- deleted 10y ago
  [deleted]
morganvachon 10y ago
> 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 back the debt (I know because I've been there). Hell, our household income is nearly $70k and while we do have enough in savings to cover such an emergency, it would still be painful and it would take us months to recover the money. Thankfully we both work for local government and have decent dental coverage, but it's a far cry from the much better health insurance we enjoy. Also, the idea that major dental surgery is "just" $3K is amusing. My bill for removing my wisdom teeth came to nearly $12K, of which my insurance paid all but $800 thankfully. That wasn't even the total cost either; I developed a severe infection and when I called my dental surgeon he told me to go to the emergency room (another $1200) to have it drained and get an antibiotic prescribed. The emergency room gave me the antibiotic but told me to go to the dental surgeon for anything else. It's a total clusterfuck.
- sjwright 10y ago
  > My bill for removing my wisdom teeth came to nearly $12K Seriously? You could fly to Thailand or central Europe and get your dental work performed there for a fraction of the price. You could probably fly business class, stay at a swanky hotel, and absorb the loss of two weeks work and still come out ahead. I'm serious. Dental tourism is a thing. I was an accidental dental tourist a few years ago while travelling around Europe. I had just arrived in Budapest, Hungary when a tooth I knew required root canal suddenly started hurting intensely. Wife found a local dentist, booked me in, the procedure was done over a couple of sessions and the total cost came in well under $1k AUD. (Your bill seems excessive even by affluent Australian standards. I had four wisdom teeth removed – one of them impacted, requiring a dental surgeon – and the total cost was under $3k AUD at my local dentist. I bet it only "cost" $12k because it was covered by insurance rather than priced by the free market.)
  - chimeracoder 10y ago
nervousvarun 10y ago
That may be true as to why the insurance is separated, but unfortunately the idea that most people can scrounge up 3K is not accurate (at least in the U.S.). Source: http://www.usatoday.com/story/money/personalfinance/2016/10/09/savings-study/91083712/ http://www.usatoday.com/story/money/personalfinance/2016/10/...
- brianwawok 10y ago
  Except that if you can't afford 3k, you also can't afford $600 a year for dental insurance.

PeterisP 10y ago

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 because of an extra middleman. Getting a broken leg or cancer is unpredictable (there are individual risk factors, but they are just as relevant for car crashes) and rare, so it makes sense to insure them. Dental care, on the other hand is common and regular - e.g. someone who didn't have coverage for broken leg or cancer most likely won't get a broken leg or cancer in the next year, but all the people who have been unable to afford dentistry generally almost all will need dentistry in the next year. 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. If you are unable to afford dentistry, then you'd be unable to afford the insurance price hike. It's not a problem of insurance as such, it's a problem of who pays for healthcare of poor people. USA has a weird historical artifact in that in the last >100 years insurance has become almost a synonym for employer-funded healthcare payment plans, not as real insurance. 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. Also, this can't solve the manner of dentistry for unemployed or underemployed people who don't get employer-funded insurance and thus a dentistry-included insurance would be as expensive or more than just paying for a dentist.

AnthonyMouse 10y ago
> 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 anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits. This is one of the reasons costs have spiraled out of control in the US healthcare market. If you need money for dentistry, ask your employer for a raise, not dental insurance.

BecuzYoullLive8 10y ago

Because our culture does not allow for providing a decent quality of life to everyone. I grew up poor, in one of the reddest of red states. I've been party to literally dozens of arguments, family, friends, coworkers, in the grocery store between randos, didn't matter who... the local cultural meme is: "You don't need teeth/glasses/asthma meds/whatever to live.". "Be glad you're not dead." is usually what follows. Poor, broken, but "alive". It isn't generally available to people with no money, so they build an emotional avoidance mechanism. A "hard living" mentality. Stoicism run amok. Politicians and neo-liberal economic policy take advantage of this. The experience may be subhuman in the figurative sense, but in a literal sense "you'll live."

rebootthesystem 10y ago

This is what you should do: Fire-up Excel and develop a financial model for providing dental insurance to a million people. On another tab, develop a financial model for providing mid-range health insurance to a million people. Finally, develop a financial model for providing automobile insurance to a million people. This will answer all your questions.

rcthompson 10y ago
Perhaps you'd like to enlighten those of us who are not experts in developing financial models for insurance scenarios?
- chillacy 10y ago
  I know nothing about insurance, but treating this like one of those crappy interview questions, I'd say you multiply the probability of an incident with the cost of that incident times 1 million people, and that's your expected cost per year. Then you look at how much you charge each person and see if they're willing to pay. Probably as someone else mentioned, dental insurance is expensive because even though routine dental work is cheaper than getting cancer / breaking a bone, it happens 100% of the time.
- rebootthesystem 10y ago
  I generally assume the HN audience to be composed of entrepreneurs or would-be entrepreneurs. Understanding finance and forecasting is a very important skill. The math is very, very simple. It's a matter of breaking down a business into costs and income to calculate profits. Again, simple math. All businesses, from a local coffee shop to a multinational share a simple equation that can be summarized through "EBITDA" analysis: https://goo.gl/A5nGML https://goo.gl/A5nGML You could start with expenses. I won't develop a comprehensive model here but here's a small list of what could cost an insurance company money. - Average number of claims per client per year - Average cost of claims - Regulatory compliance costs - Administration costs - Structural costs (buildings, desks, computers, cars, phones, etc.) - Cost of sales - Personnel costs (salaries, health insurance, benefits, taxes, HR, etc.) Spending some time on Google would reveal lots more detail on how to create a model on the expense side. If you can find a publicly traded insurance company their SEC filings would contain lots of useful information on cost drivers in that industry. I would definitely look for these filings if available. Next do income. Simple version: How many clients? How much do they pay on average? Complex: You need to divide clients into layers with different risk profiles. Each risk profile is likely to have to pay different premiums, etc. This connects with the cost side of the equation. I listed average cost of claims above, this isn't likely to be a realistic cost model. It might be OK for a quick first stab but you really need to model cost of claims in tiers with some relationship to statistical risk, etc. This requires some thought. Google, again, could be your friend here. In some ways, to talk in programming terms, you almost want to create a class to represent an individual client (with all the relevant variables) and then instantiate a million of them by using realistic distribution criteria to decide how these variables, well, vary. For example: Out of a million people, in any given year: What's the likelihood of a non-fatal heart attack? What's the likelihood of broken bones? What's the likelihood of hospitalization? You then have to attach costs to these events. You would then have to add a matrix of plans with different coverage structures, deductibles, etc. These plans will interact with the above to generate actual costs. Some people will have very low premiums but huge deductibles and light coverage. Others will opt for very higher premiums for more coverage and still have a deductibles structure. Google can provide ideas on what's out there. This can get very, very complicated. The simple version can give someone a basic understanding of what's at play. Bottom line, there's a reason for which comprehensive dental insurance isn't commonplace and this kind of analysis reveals it. To those of us used to the financial analysis of businesses the answer to this question is clear. I think it is important for people to try and understand how money works. A lot of the issues out there boil down to the masses not having this understanding. Every day politicians promise things that are firmly rooted in fantasy, a fantasy that is easily revealed with a quick dive into a spreadsheet. This is a huge problem.

drcnyu555 10y ago

Dentist here , I agree that many people can't afford desired treatment. It's common occurrence in a Dental office. Having the insurance still makes one liable for deductible ( entry money to seek any treatment ) , co payments and other hidden costs . That's how the system is designed.

fav_collector 10y ago

Dental insurance isn't even really insurance so it isn't comparable to medical insurance since there are no out of pocket maximums and the maximum benefit is pathetically low. It's basically a dental care/maintenance subscription and if you need any major work, you're going to pay $$$.