For comparison the median salary for dentists in Sweden is $51 500 [0]. The reason for the high salary in the US is not the expensive education ($100 000 extra per year buys a lot of education), it's the high income inequality [1]. The expensive health care with few incentives to lower the prices of course helps.

[0] http://www.lonestatistik.se/loner.asp/yrke/Tandlakare-1241

[1] https://en.wikipedia.org/wiki/List_of_countries_by_income_eq...

I don't think "high income inequality" is much of an explanation for why someone has high income...

It is certainly a part of it, McDonalds workers earn about twice as much in Sweden as in the US. There is no good reason why a dentist should earn 10 times as much as a McDonalds worker, people still work hard to get those jobs even when they just pay 2-3 times as much like in Sweden.

I'm sure the dentist worked harder to become one, or has more talent, to make 10x more than McDonald's worker. The latter can be done by anyone... It's absurd to compare the two...

Why is the comparison itself absurd? Both are just normal people that work all day. I guess whether the dentist "should" earn 2x or 50x is a matter of values and culture. As such I find it quite reasonable to attribute the high dentist salaries in the US to the population's high tolerance of the high income inequality.

Simple question: would you prefer to have your teeth fixed by a burger-flipper, or to have your burger flipped by a dental school graduate?

Second question: would you prefer living without well-cooked burgers, or live with bad teeth?

The difference in value is there.

Nobody is questioning whether dentists should be payed more than fast food workers, it's just how much more.

Another example: brain surgeons have an average salary in the US of $450 000 [0], in Sweden it's $65 700. I would agree that there is some room for higher salaries for people with advanced degrees in Sweden, but I also think that the income inequality in the US is way too high. It's a cultural thing.

[0] https://www.payscale.com/research/US/Degree=Doctor_of_Medici...

[1] http://www.lonestatistik.se/loner.asp/yrke/Hjarnkirurg-5131

It seems like the defense you have been required to make is just proving your point. People appear almost offended and baffled at your comments which are easy to understand.

They are also overlooking the basic facts that healthcare in Sweden is significantly better than in the US despite the significantly lower pay scale, Sweden has a higher median income, and the quality of McDonalds food and service is probably better as well (it has been anywhere I have been in Europe).

I think that what people are missing is the premise of acceptable level of exploitation.

In the U.S., there is no limit on this. The violence of poverty is completely overlooked as is the incredibly uneven playing field.

The healthcare industry is set to extract maximum profit with minimum service and people who cannot afford the premiums are left without care options/face bankruptcy.

This is just one of the many forces increasing income inequality.

Similarly, education is expensive not because it costs that much but because it is set to maximize profits.

I’d say that dentists making 150k is less of an issue than the fast food workers making 1/8 of that with minimum wage which has not increased in decades and a house median cost is above 600k-1m.

Human beings are not seen as having dignity or value beyond the exploitable.

>Nobody is questioning whether dentists should be payed more than fast food workers, it's just how much more.

This doesn't actually answer any questions or address any actual issues, unless you're willing to force dentists to work with your so-called "appropriate salary" with the full force of the law.

Draconian slave camps where people are forced to practice dentistry aren't actually necessary to address the issue; we can just look elsewhere and compare.

What virtually all advanced democracies have done is rather make a judgement about what kinds of fees are reasonable to pay for dental and medical services, and limit what the national health insurance system will pay to that.

Then see if anybody is willing to practice dentistry. They usually are.

(Also, in most, if not all, of these countries, dentists are free to charge any rate they wish for dental services, and if they can find enough people willing to pay those fees with their own money, instead of using the national health insurance system, that's fine, too. But that's typically not necessary, and hence not common.)

I have known some pretty terrible dentists and they still make a crap ton of money or just rip people off. There isn't some universal truth associated with the amount of money you make and how good you are at your job. This is the entire problem with the medical industry in the United States. For the most part you can look for recommendations, reviews, and find the right physician; for other cases where options are limited or this isn't available you don't have much you can do but be ripped off or suffer from poor service when it happens. Usually poor service and being ripped off tend to go hand in hand. It's obviously not always like this, but there are conditions where you have little choice

10 McDonald's workers can't fix your teeth. 10 dentists can be equally as good at making hamburgers. They also invested hundreds of thousands of dollars into education. So yes they deserve to make significantly more money.

> 10 McDonald's workers can't fix your teeth.

But a Swedish dentist definitely can even though he just earns twice as much as the guy flipping burgers, I don't see your point. The only reason to pay a worker more is to attract more talent to the profession, and Medicine is the field that is by far the most selective in Sweden meaning that they already get the best talent. The only thing you would accomplish by paying them more is making healthcare less affordable for the people.

I like this, Here is my try:

10 CEOs can't fix your teeth.

Does sinking hundreds of thousands of dollars into education make people who studied arts / humanities deserve a proportionately higher salary as well?

Why should that education cost so much though? Not really anything, right? That's why socialized education is so valuable, because people do what they feel passionate about regardless of 'investment' cost.

Because being surrounded by nice buildings and experts in their respective fields while living in densely populated cities isn't free. Who would've thought? If you're truly passionate about something, you're not going to let something as meager as tuition cost get in the way of it.

"10 McDonald's workers can't fix your teeth. 10 dentists can be equally as good at making hamburgers."

That is incredibly arrogant and so far wrong it's not even close to the truth.

>That is incredibly arrogant and so far wrong it's not even close to the truth.

This seems like fact to me. The whole point about McDonalds is that they have perfected their processes so well that there is very little difference in quality and output between someone who has spent 20 years making hamburgers and someone who has been there a month.

If someone is capable of being a dentist, they can likely make hamburgers. The reverse is probably not true - some portion of the people making hamburgers likely don't have what it takes to make it through dental school.

How much do you know about McDonalds? These aren’t artisan burgers. I see no reason why a dentist, should he or she have the desire to do so, couldn’t be trained to perform the task that is being a cog in the McDonalds burger factory in at most a few days. On the other hand, training to be a dentist is going to take a lot longer.

Can you explain how this is wrong?

Of course I can explain it. First, it assumes that learning to do dentistry work requires something extraordinary but the only thing it requires is the resources (time and money) to go to school.

Not everyone who gets through school gets high marks, and of those that get high marks not all of them are necessarily inclined to be good with the tools they use.

I've known of some pretty awful dentists who tended to do as much damage to their patients as they did repairs. I have no reason to believe they'd be any better at making burgers or anything else they attempted to do.

And it takes arrogance to believe that a degree makes you superior to those who don't have one. The truth is it takes longer to become proficient in some skilled labor trades than it does to become a dentist, and it take more actual skills to do the work.

I've never met a dentist who could tear down a small block Chevy engine and rebuild it. Not one. I've never even met one that could change the oil on one, but I've known kids who learned how before they were 12 years old.

Finally, some of the most brilliant people in history, some of the greatest engineers, designers, and inventors, are people who spent very little time in school and none at all in any kind of higher education.

If you think everyone who's making your burgers is less intelligent, less capable, less creative, than yourself you are an arrogant fool.

Your response is all over the place and off the mark.

You sound like someone who has never had to pass advanced exams to proceed with much higher levels of education.

I have relatives who are dentists. They are extraordinary in their precision. If you think it just requires time and money you clearly will never pass med school.

Awful dentists? Yes, every field has people of bad ethics. The very word "mechanic" conjures up images of incompetent lying men who will rip you off and ruin your car. What's your point?

Arrogance - nobody said anything about better. Just better at being a dentist and that learning how to flip burgers is easy.

I know a doctor who can rebuild engines. He is also a painter and a soldier. What's your point? The intersection of dentists and people who want to mess with engines when they can easily is small. It has nothing to do with ability. Changing oil takes five seconds to learn. Have you ever diagnosed an error on a chip with an oscilloscope? I have. Does that mean you are stupid or simply haven't cared to do so?

Everyone who makes burgers is less intelligent, less capable, and less creative than me is a different statement than "making burgers doesn't require the same level of intelligence, capability, and attention to detail as dental work".

Tell me, since you're so good at rebuilding engines, how good are you at rebuilding without turning it off? Without making a mistake? Fixing engines and dentistry aren't comparable, much less flipping burgers.

The belief that there are no genius burger flippers is what is arrogant. You apparently missed that this is the point I am making.

"I have relatives who are dentists."

And that obviously influences your take on this issue. I didn't insult or demean your relatives, I just don't have good reason to believe they're "special" because they're dentists.

"The very word "mechanic" conjures up images of incompetent lying men who will rip you off and ruin your car."

"Changing oil takes five seconds to learn."

That is exactly the kind of arrogance I'm calling out here. The truth is, pulling a tooth takes about that long to learn too, and the tools used aren't that much different.

Don't believe me?

Come on over and I'll pop one of your teeth out in about 5 seconds without ever going to school to learn how and I'll use the same tool to change the oil on my lawn mower ten seconds later.

I'd like to add:

-malpractice insurance -administration/documentation costs

The procedure price in the US has to account for filing the claim, issuing the patient an EOB, then going through the adjudication process, then finally billing the patient for the copay/deductible payment, a percent of which will likely have to be written off.

Can you provide any insight into the market forces keeping dentist salaries low in Sweden? High supply / low demand / salary/insurance caps / lower cost of living / non-salary benefits / etc.? (In the US we have the opposite of these… artificially low supply, private insurance hides costs, high cost of living in urban areas…)

It's not considered a low salary in Sweden. Engineers have a median salary of $51 500 [0], lawyers $55 200 [1]. The spread between low and high salaries is much lower, and there's some discussion of trying to raise the salaries for advanced degrees to increase the incentive for education.

[0] http://www.lonestatistik.se/loner.asp/yrke/Civilingenjor-116...

[1] http://www.lonestatistik.se/loner.asp/yrke/Advokat-1066

I was thinking of this a couple of days ago when an uninsured person got an estimate of $25,000 for dental surgery. https://twitter.com/ForgetAmnesia/status/912456274532585472 https://twitter.com/ForgetAmnesia/status/912369049958584320 I wonder if the increasing specialization is driving costs up too. If you have fewer patients you might feel pressure to charge each one more instead of admitting that you picked too small a niche.

It absolutely shouldn't account for such a large discrepancy, but is the level of expertise the same? I would also expect that the US dentist has paid much more for their education.

Did the US dentist go to school longer? As I said, I'm sure they paid more. Is the US dentist more skilled at their job? Are the requirements to practice dentistry lower in India? Are the results better or worse in India?

You also mentioned the lower wealth in India. There is also a lower standard of living cost. Costs for products and services have long-since been decoupled from expenses and people charge what they think the market will bear.

Also, is there a greater supply of dentists? My understanding is that the AMA artificially limits the supply of medical doctors, but I'm not sure about dentistry. I also have no idea what it's like in India.

Given what little I know of the situation, I suspect I'd support the idea of Indian dentists making more money, not US dentists making less money. I believe teachers and medical professionals should be well paid. $150,000/year isn't that much. We have programmers who make larger salaries, and they don't even give me a free toothbrush.

Edit: Google tells me that the average salary in India is $616, so the average Indian dentist makes about 8.5x the average income. That's about $225,000 in the US.

>Did the US dentist go to school longer? As I said, I'm sure they paid more. Is the US dentist more skilled at their job? Are the requirements to practice dentistry lower in India? Are the results better or worse in India?

I assume the phrase "no amount of safety is enough" when it comes to health care is a false statement, it's an economic problem: Am I/is the population willing to pay 1000% (10x) more for say, 2% to 1% (2x) improvement chance in the person fucking up my teeth?

With that in mind, I wonder is going to school for a long time necessary? I think we have a return-on-investment curve (or time in school vs chance that the person fucks up) that plateaus at some point here. Maybe it plateaus where the Indian requirement is, and people in the US stay in school too long for very little returns.

> Am I/is the population willing to pay 1000% (10x) more for say, 2% to 1% (2x) improvement chance in the person fucking up my teeth?

As someone with permanent nerve damage from having my wisdom teeth removed that makes me look like a fucking stroke victim when I smile...yes, absolutely

Sorry to hear.

We take a risk every time we do something. It doesn't mean that you'll absolutely be guaranteed by paying 10x more that you won't have a botched surgery, it's just less likely. Someone would say they are willing to pay 10x more for 2x less the chance, given they had an accident. The problem with that was I don't think the population will be happy adopting an 80 USD toll road and $25 per gallon for 2x less the chance of a car accident, even if that could be done. I think safety tradeoff is easier said than done.

Where did you have it done?

I ask because you did pay 10x more if you had that dentistry work done here in the US and the outcome is as you've described.

Yep, in the U.S. So I suppose the slightly lower risk didn't work out for me, but if I had to advise anyone else on the hypothetical decision, I'd say pay 10x more and get the slightly lower risk. It's not enough money to save given how shitty the consequences can be.

Wow.

I've been advised by a dental surgeon to not take off my wisdom teeth because of this.

Did you receive warnings about it before surgery?

This is a tough one -- inferior alveolar nerve damage is the most common long-term complication in third molar extraction -- I advise about 1% of my patients against extraction based on the proximity of their lower molar roots to this nerve. However, there is great anatomic variation in the course of the IAN such that damage to it can occur even when pre-op radiographs show that there is little risk of hitting it. (Which is to say... SURPRISE, there's a nerve where you didn't expect it!) Sorry to hear it, OP, AND I hope you don't have permanent lingual paresthesia -- having a numb tongue is nearly impossible to acclimate to...

Wisdom tooth removal is no different from any other surgery, and as such you are likely to get the same "blah blah you could even die" speech. I did.

We know that going to school for a long time isn't necessary , for the most common procedures dontists do: filings and x-rays . We know that because a few western countries, with public healthcare,have dental assistant with a 1-year degree that do those things.

I'd say that safety certainly has a price point where people will change their minds, even if they don't want to admit it.

That's fair but a major problem with US healthcare is that there isn't really many options around cost trade-offs. We have them in every other consumer industry - a loaded luxury car offers different trade-offs than a used subcompact. Why don't we have the same choices in health care?

My grandpa has cancer and is getting chemo, the chemo seems very expensive (at least 100x more expensive than the same molecules but without FDA certification in India). However, the hospital bills each intramuscular injection at $200. An intramuscular injection is the same injection as a flu shot. Now, why can I get a flu shot for $20 at walgreens but a hospital charges $200 to perform the same sort of shot with a different payload?

And why can't we trust people to do it themselves? Diabetics stick themselves with needles routinely with pretty basic training.

I wonder how much my health insurance would be if I could forego check ups, promise not to use insurance to cover on-patent medication, and DIY my healthcare as much as possible. And I'll keep wondering because apparently a lot of that would be illegal.

>That's fair but a major problem with US healthcare is that there isn't really many options around cost trade-offs. We have them in every other consumer industry - a loaded luxury car offers different trade-offs than a used subcompact. Why don't we have the same choices in health care?

Plus, the bizarre system of "You can only change once per year and in specific windows or for a major life change".

I believe the only realistic option is single payer. Elsewhere in the thread, I voiced my displeasure at using insurance for regular medical care. I think using insurance for regular care is silly. Doing so and complaining about the prices borders on insanity. It's like expecting your auto insurance to cover a tuneup.

Also, all the operational overhead in that US dentist office will cost more than the Indian side. The secretary, the assistant, the building lease, etc. (I'm not saying that we can't fix the problem of overpriced healthcare, I'm just saying it's a contributing factor)

Strangely though, the US enjoys lower prices for consumer goods like fashion brands, and consumer electronics. Nike shoes and a Sony TV will be more expensive in India than the US.

> Strangely though, the US enjoys lower prices for consumer goods like fashion brands, and consumer electronics. Nike shoes and a Sony TV will be more expensive in India than the US.

That's not strange at all. India has import duties on many goods, especially electronics.

I have been considering medical tourism for this reason. But moreover, I see doctors responding to the strangulation of the sector by insurance companies by offering less care for more money. I can go to Costa Rica and get a lot of things sorted for a fraction of the costs and many of the doctors are trained in the US anyway.

It doesn't make sense to compare salaries between US & India on a US$ perspective. Indian salaries are lower in terms of USD, but the cost of living is also lower - basically the 5$ USD meal at McDonalds in US costs maybe 1$ USD in India. If you are paid "less", but everyone else is paid "less" too, then goods/services are cheaper - so the actual goods/services you can purchase will be the same for a much lower salary in India. Lookup purchasing power parity.

It might be more sensible to compare how much more dentists make than the average income. i.e Average dentists salary / average salary.

For US I get - 175350/55775 ~ 3x

For India its 8.5x

So dentists are probably pretty well paid in terms of the standard of living they can purchase.

It does make sense to compare them on a USD basis if you trying to figure out what causes a 10x difference in x-ray cost between the U.S. and India (in USD)

Read up on purchasing power. Purchasing power is what your money can buy, which is the more correct measure.

Its the same reason it doesn't make sense to directly compare programmers salaries in San Francisco vs. Pittsburgh. If (made up numbers) 120K$ in SF buys the same lifestyle as 90K$ in Pittsburgh, it means someone making 120K in SF is roughly as wealthy as someone making 90K in Pittsburgh. Certainly saying that the SF programmers make 1.3x more is true, but the more fundamental question is the lifestyle that the income affords you.

Kinda-sorta. With a higher salary, living a below-average lifestyle for the area can lead to staggering savings rates and savings in absolute terms. For instance, saving even 23% of 120k is better than saving 30% of 90k.

And of course a lot of things cost the same regardless of where you live. Manufactured goods cost pretty much the same in India as in the US and sometimes more, because of import duties. Gasoline is significantly more expensive.

Right.. now going back to the India/US comparison, its pretty fair to say 99% of people in India will not immigrate to the US. So the hypothetical value of saving lots of money in the US to spend in India doesn't really apply. The SF/NYC analogy does not hold exactly to US/India.

Who said anything about saving in the US to spend in India? Saving in the Bay Area to spend in rural Montana is an equally valid comparison, cost-of-living wise.

The point I was making is that some things cost the same no matter where you live. The Indian dentist who wants to take a foreign vacation, buy an iPhone, or a car needs to spend more, relative to her income, than the American dentist. Purchasing power only holds for things that are labor-bound (mainly services, and goods that are labor-intensive to manufacture) rather than resource-bound.

Purchasing power is based on a basket of goods for the average consumer. It takes into account expenses like phones and cars - as you say, iPhones are still expensive but the basket would take that into account and purchasing power would be lowered accordingly.

Unfortunately, no. Purchasing power differs across economies. While exchange rate correlates with purchasing power, it's merely a rough measurement, not something you'd base analysis on.

The average proportion still doesn't make sense. Because the large population depresses the national average income greatly. On the other hand if you are comparing spending power I feel it should be more accurate to include GDP Per Capita (Purchasing Power Parity) in your calculations.

US GDP per capita nominal = 57.5K USD, US GDP per capita PPP = 46K USD. This gives a PPP-to-GDP ratio of 0.8. The average dentist salary is 175,350 USD (nominal). So the US average dentist salary (PPP) is 140,280. This finally gives you a dentistSalary-to-nationalAvg (PPP) of 3.

Now, I'll do these same calculations for India. GDP per capita (nominal) is 1.7K USD and in PPP terms it is 6.1K. This leads to a PPP-to-GDP ratio of 3.6. In India the average dentist salary is 312,797 INR according to payscale. This is equivalent to 4750 USD (nominal). In PPP terms, this is equivalent to annual salary of 17.1K USD (PPP). So finally we have a dentistSalary-to-nationalAvg ratio of 2.8 for India.

So our metric is 3.0 for the US vs 2.8 for India.

Most statistics were obtained from Tradingeconomics.com which also appeared on top of google searches. I may also have screwed up my calculations somewhere, but I don't know.

A Big Mac in India costs $2.76 USD vs $5 in US. See the Big Mac Index [1]

1. http://www.economist.com/content/big-mac-index

At least when I used to live in India 6 years ago, A Big mac was a 'fancy' meal rather than the cheapest meal possible. I don't think the index applies.

Bigmac is not the cheapest meal. A double cheeseburger is about 1/3 the price.

In my case most often it’s a hygienist who takes the x-rays, not the dentist. But even assuming it’s the dentist, and the dentist is paid at 200k/y, that translates into $100 per hour or about $1.7 per minute. It never takes more than 10 min to do the x-rays, so the labor cost of a set of x-rays can be at most $20, most likely much lower.

What does the iPhone cost in India? Has Apple subsidized it?

It is the opposite. iPhone costs at least 20% more in India.

Rs. 24,490. About $380 USD.

Prices as of September 2017, currency conversion via Google on today's date and time.

where do u see a new iphone for that price in India ? For Iphone 7, I am seeing at least $1000 USD when converted from INR. Officially on Apple website.

https://www.apple.com/in/iphone-7/specs/

It was the 6s which I mistakenly read as the 7s.

http://pricebaba.com/mobile/pricelist/apple-price-list

My bad.

There is no iPhone 7s.

True, but that didn't stop me as misreading it as the 7s. I'd already read the 6 as a 7. The reading comprehension train had already left the station.

Durable goods (especially from the same manufacturer) cost about the same across the world.