5 ms·

It boggles the mind. By the time I graduate I will owe about 1 year's projected income (about $70k) and I think that's a pretty good return. If a dentist can

It boggles the mind. By the time I graduate I will owe about 1 year's projected income (about $70k) and I think that's a pretty good return. If a dentist can make back nearly half a million then something needs to be done about the cost of dentristry, something doesn't add up.

ck2 13y ago
I think that is the point, they cannot easily make back the $400k I have to go to the dental college because I do not have insurance, it is impossible to go to a dentist without insurance these days. I usually am seated among many other people at the college who actually have insurance, it is just their deductible is far too high unless they go to the dental school for work.
jjoonathan 13y ago
I don't know how it works for dentists, but my understanding is that for doctors we've essentially given the doctors' guild the ability to legally dictate how many medical graduates they will allow, making them the envy of unions around the world (and schools, who are very happy with an arrangement that allows them to auction off a restricted supply of meal tickets). Sometimes you'll hear the AMA blame congress because they've gotten congress to pay for part of the education process and it hesitates to periodically increase the handout, but the reality is that they could change things tomorrow if they wanted to. Which they don't, because they rather enjoy the sky-high salaries that come from the artificial scarcity they've created. The market is slowly working around this constraint by allowing nurses to train and take on some of the responsibilities that were previously subject to the artificial labor scarcity. Unfortunately this only represents about ~1/3 of the problem with our medical industry by market share. The other two thirds come from drug price overruns (US drug buyers pay twice as much as single-payer countries which have much more size = bargaining power) and the medical insurance industry (a textbook case of "costs of competition" dramatically exceeding the benefits in a measurable way).
- carbocation 13y ago
  > The other two thirds come from drug price overruns (US drug buyers pay twice as much as single-payer countries which have much more size = bargaining power) As an infuriating elaboration on your point, the United States has a huge single payer in Medicare that is by law prevented from effectively negotiating drug price.
  - jjoonathan 13y ago
    Yes! It's insanity! Well, I wish it was insanity. It's actually cold and calculated exploitation. This is why we need campaign finance reform. Under the current system, politicians don't have the freedom to reject bribe money even if they want to. What a mess.
  - refurb 13y ago
    Medicare isn't allowed to negotiate, but it automatically gets the average selling price, inclusive of all discounts. Disproportionate share hospitals get 23.1% discount. It's not like the US gov't isn't extracting it's share. Medicaid IS allow to negotiate and has federally mandated discounts. Medicaid covers more people in the US than ANY of the Canadian provinces who do negotiate. What does that tell you?
    - jjoonathan 13y ago
      Methodology is important. See here: http://www.law.cornell.edu/uscode/text/42/1395w-3a http://www.law.cornell.edu/uscode/text/42/1395w-3a > the manufacturer’s “average sales price” means ... sales to all purchasers ... in the United States ... divided by the total number of such units So it looks like the ASP is fixed to the shit price that results from fragmented bargaining by US companies. A 23% discount on a 100% markup = drug companies laughing all the way to the bank. As for Medicaid, I'm not familiar enough to answer. Do they get decent prices or is there similar corruption at play?
      - msellout 13y ago
        Medicaid does get decent prices, but providers may refuse to accept Medicaid. So some people have no access to affordable care, despite having Medicaid, because none of the providers within a reasonable distance accept Medicaid.
will_work4tears 13y ago
Yeah, apparently the median salary of a dentist is ~145k with the highest earners making almost 190k and the lowest earners making ~75k. More of a relative hit than a CS type for sure.

ck2 13y ago

I think that is the point, they cannot easily make back the $400k I have to go to the dental college because I do not have insurance, it is impossible to go to a dentist without insurance these days. I usually am seated among many other people at the college who actually have insurance, it is just their deductible is far too high unless they go to the dental school for work.

jjoonathan 13y ago

I don't know how it works for dentists, but my understanding is that for doctors we've essentially given the doctors' guild the ability to legally dictate how many medical graduates they will allow, making them the envy of unions around the world (and schools, who are very happy with an arrangement that allows them to auction off a restricted supply of meal tickets). Sometimes you'll hear the AMA blame congress because they've gotten congress to pay for part of the education process and it hesitates to periodically increase the handout, but the reality is that they could change things tomorrow if they wanted to. Which they don't, because they rather enjoy the sky-high salaries that come from the artificial scarcity they've created. The market is slowly working around this constraint by allowing nurses to train and take on some of the responsibilities that were previously subject to the artificial labor scarcity. Unfortunately this only represents about ~1/3 of the problem with our medical industry by market share. The other two thirds come from drug price overruns (US drug buyers pay twice as much as single-payer countries which have much more size = bargaining power) and the medical insurance industry (a textbook case of "costs of competition" dramatically exceeding the benefits in a measurable way).

carbocation 13y ago
> The other two thirds come from drug price overruns (US drug buyers pay twice as much as single-payer countries which have much more size = bargaining power) As an infuriating elaboration on your point, the United States has a huge single payer in Medicare that is by law prevented from effectively negotiating drug price.
- jjoonathan 13y ago
  Yes! It's insanity! Well, I wish it was insanity. It's actually cold and calculated exploitation. This is why we need campaign finance reform. Under the current system, politicians don't have the freedom to reject bribe money even if they want to. What a mess.
- refurb 13y ago
  Medicare isn't allowed to negotiate, but it automatically gets the average selling price, inclusive of all discounts. Disproportionate share hospitals get 23.1% discount. It's not like the US gov't isn't extracting it's share. Medicaid IS allow to negotiate and has federally mandated discounts. Medicaid covers more people in the US than ANY of the Canadian provinces who do negotiate. What does that tell you?
  - jjoonathan 13y ago
    Methodology is important. See here: http://www.law.cornell.edu/uscode/text/42/1395w-3a http://www.law.cornell.edu/uscode/text/42/1395w-3a > the manufacturer’s “average sales price” means ... sales to all purchasers ... in the United States ... divided by the total number of such units So it looks like the ASP is fixed to the shit price that results from fragmented bargaining by US companies. A 23% discount on a 100% markup = drug companies laughing all the way to the bank. As for Medicaid, I'm not familiar enough to answer. Do they get decent prices or is there similar corruption at play?
    - msellout 13y ago
      Medicaid does get decent prices, but providers may refuse to accept Medicaid. So some people have no access to affordable care, despite having Medicaid, because none of the providers within a reasonable distance accept Medicaid.

will_work4tears 13y ago

Yeah, apparently the median salary of a dentist is ~145k with the highest earners making almost 190k and the lowest earners making ~75k. More of a relative hit than a CS type for sure.