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.

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.

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)

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.

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!

Dentists far too often recommend extraction for wisdom teeth when it's unnecessary, probably because they can charge a hefty fee for it.

These things are not preventable, you were just born lucky. Remember, humans didn't usually live to become 50 years old.

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.

(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.)

[0] http://en.wikipedia.org/wiki/Hypodontia [1] http://www.nytimes.com/2011/11/27/magazine/can-the-bulldog-b...

> (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...

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.

  > My wisdom teeth actually fit in my mouth. Because
  > I took care of them

Whether or not your wisdom teeth fit into your mouth or grow in the right direction is not a matter of 'proper dental hygiene.'

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.

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.

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.

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.

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.

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.

Dental care is essential. Even if you don't have pain, constant inflammation can cause you all sorts of problems.

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?

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.

Children get free treatment.

Finding an NHS dentist can be tricky.

So for example removal of tooth would be: dentist 9.60 € /visit + tooth removal 13.80 – 27.50 €

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.

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).

And doctor's visits for non-residents are about $40 in Ontario.

(Getting three wisdom teeth removed did not appear to cost that much either, but my insurance paid for that.)

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.

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.)

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.

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).

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.

Yeah, not cheap.

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.

Don't ignore the unusual pains.

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.

Wait! The US has universal healthcare?

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.

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.

[1] http://www.wolframalpha.com/input/?i=health+care+cost+per+ca... [2] http://www.wolframalpha.com/input/?i=life+expectancy+USA+vs+...

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.

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.