I never pay for this.

"No cavities again! Would you like a flouride rinse?" "Why would I do that? I have flouride in my mouth rinse and my tooth paste." "Well, ours is a higher concentration that I paint onto your teeth." "Didn't you say I had no cavities?" "Well, yeah." ".... so what I'm doing seems to be working without your rinse" "Well, it's only $16" "My flouride rinse has the exact same active ingredient as yours and costs $5 for an entire bottle." And it just goes on and on.

Yes, our medical/dental insurance industry has encouraged the attitude of “cost doesn’t matter, because it’s free to you (oh and besides, you can’t put a price on your health, can you, you cheapskate?)” which just serves to constantly let prices grow out of control. This is an instrumental part of how our healthcare costs got so high. It also is why it’s laughable to think of medical care as a free market: you can’t even find out what things cost before you buy most of the time. Not to mention that when you are in need of care, you often don’t have the luxury of shopping around.

What we really need is for people to stop thinking of insurance as a big blanket you buy that reduces the price of things to zero. That’s not what insurance is for. Insurance is supposed to be a system where you still pay for the cost of the good, but that buffers it for you so when you get an outlier cost, it doesn’t break you. It doesn’t make the costs of things go away. On average, you should end up paying a little more than the cost of your healthcare by purchasing it through an insurance plan. A high deductible plan does this: you actually pay the cost of all your healthcare up until a certain point out of pocket, and if you reach a certain amount (which is pretty high, but significantly less than the premiums on a low-deductible plan), the insurance takes over. This makes you actually aware of the prices of things and is healthy. Not to mention the insurance is a hell of a lot cheaper.

How effectively can you actually shop for medical care? Providers lobby against public measures of effectiveness so basically only payers have enough data to actually judge who is effective and people scream when their doctor choice gets restricted for any reason.

I don't think consumers budgeting can realistically be the control on the growth of healthcare costs. For one thing, people's budgets vary too wildly.

Healthcare should simply be "free", ie budgeted into the operation of a modern society, like infrastructure costs and education.

Oh, I completely agree with this. In the meantime, the HDHP and acknowledging that, yes, you are paying for your healthcare is the best option.

Just take all of the money you'd otherwise spend on dental care and put it into a savings account or FSA.

I've never seen a dental insurance plan that actually makes financial sense. Most of them place significant limits on expensive and unlikely care, and cover routine care with little or no cost sharing. Insurance is a highly inefficient way to pay for expected expenses.

Dental insurance via employer is mostly just a way to pay for dental healthcare via pre tax dollars.

And FSAs do that without the insurance company overhead.

Yes, the only downside I can think of is if you have an HSA (which anyone that can afford max out of pocket limit should), then you generally cannot have FSAs also unless they are Limited Purpose FSAs and then it gets too complicated for my tastes. I generally do not like the concept of FSAs period, being employer owned, and having to use up funds by the end of the year and all.

Agreed. I only put money in an FSA that I know I am going to use. But for my routine cleanings/xrays/etc, this is pretty easy to calculate.

The dentists peddle that nonsense because it is almost all profit for them. Insurance will not cover it because there is no strong evidence that it helps, assuming you are brushing your teeth regularly, have access to fluoridated drinking water, and otherwise have healthy eating habits.