Dentists and Orthodonists

Tragic, indeed, but isn’t this the ultimate result of “help the poor and only the poor, not even the working class” social policies of the 60’s and 70’s. These ideas were shared by LBJ and the New Left ( of which Madison, Wis., was and is a hotbed) alike. Would not things have been better, for the poor as well as everybody else, if back then a universal welfare state and mixed economy been established? One would think so.

P.S. It is not only difficult for the poor to get dental care. Many middle-income people have great problems as well, unless you are on a plan-and sometimes even when you have one.

Look! I am not going to blame this or that political party. The real problem in part is that going to a dentist on a fairly regular basis is an elective visit, and as such, those without the resources tend to skip dental visits…and then, later, of course, the problems that have built up begin to kick in and serious dental work is needed. If your teeth don’t bother you, why spend money to have them looked at? etc

“But Medicaid reimbursement rates for dentists in Maryland—as in many states—are set at such low rates that few dentists accept Medicaid patients.”

This is part of my worry about government funding in health care in general. If you price below market, you get shortages because people don’t like to lose money when they work. This created an informal rationing effect. Formal or informal, rationing seems likely under any currently discussed model of US healthcare.

As an American, it is difficult to get over the average dental quality of the English. I’ll grant you that straight teeth are not as important as dentists make it out to be over here. But there is one advantage. When you take pride in the appearance of your teeth, it is much easier to get people to adopt regular cleaning habits. Its anecdotal of course, but it seems to me the difference there b/w Americans and the English is still quite noticeable, and that is important.

You could move to the UK or Ireland and save those orthodontia expenditures.

I don’t look back with fondness on orthodontia bills, but in retrospect it was helpful for my daughter (who knows how much peer influence contributed to that?). I’m sure all of us parents have been pressured here and there to undertake expenses that are lot less useful than orthodontia typically is.

And isn’t dentistry a profession in trouble for a variety of reasons, most of which probably have nothing to do with the government?

Americans have the stereotype that British teeth are awful. Are they really any worse that other Europeans’ teeth? I reckon it’s a hangover from the days of cheap sugar from the West Indies, just as the Dirty Frenchman has been banished by improvements in urban plumbing there since the 60s. Really it’s the Americans who are the outliers with their legions of middle-schoolers wearing braces, and adults whose gleaming gnashers would elsewhere be suspected of being fake. Which they sort-of are. How long before cheek implants and botox are included in the medical plans of better-off Americans?

Good luck with the potentially expensive teeth! I was given orthodontia, but I hated it so much that I rarely wore the stuff that I needed be wearing to make more than a little progress.

Of course, that basic dental care (Jim S, link please on your contrary allegation?) is pretty-well supported by most current private insurance. Which is why I think the poor’d be better off if we gave them money to find their own insurance, and give individuals the special treatment now given to companies for inrurance policies with prior conditions.

There’s another problem with Medicare and Medicaid that’s not so obvious: its reporting requirements are long, incomprehensible, and contradictory even to professionals. That exacts a high hidden cost.

I did some work on a medical application once. One of its big selling points was being able to generate Medicare/aid – style filings. It took a LOT of long work to make even part of that work.

And, ABB, it’s not a rationing question. Trust me, Medicare and Medicaid of MD certainly have plenty of money, enough, indeed, say to pay for private dental insurance for everybody enrolled. No, the problem is that monopoly has allowed bad performance. They probably pay too little for even the doctor’s time, and require very high amounts of office labor overhead for claims (good luck getting THAT reimbursed!).

“dentists really do matter”

You bet. For example, there is a recognized association between dental infections and atherosclerosis. The explanation, perhaps, is that chronic activation of the immune system (from the infections) promotes the formation of arterial plaque. So please floss for your heart’s sake.

Dentistry is one of those apparently simple and widely undervalued things which, if done well, would prevent illness and alleviate suffering. (But like primary care, doing it well isn’t so simple.) The glamour (and money) in health research, however, often descends upon things with no current recognized therapeutic application (e.g., 99% of genomics).

The Howard government in Australia, under severe pressure, just restored funding for dental services, having dumped this on the states ten years ago. The accidental fact that dentistry is a separate profession seems to contribute to a view that it’s an optional extra in health policy.

Don’t look at me, he said with a crooked grin (despite years of adolescent orthodontia). I’m trying to to transcend dental medication.

This is part of my worry about government funding in health care in general.

Can anyone enlighten me: how is ‘the market’ going to fix poor people’s teeth, or health, for that matter?

What Jim S and abb1 said, what novakant alludes to.
Not what Sebastian H. said:
“This is part of my worry about government funding in health care in general. If you price below market, you get shortages because people don’t like to lose money when they work.”
A market that’s providing goods and services as life-essential as medicine and dentistry can potentially extract everything every last resource from the hapless and helpless and as we’re seeing now they will and they are. Check the process of the elderly slipping into “managed care” for starters.
The price on a loved one’s life or health is not something a mentally sound human being would ever attempt to set in dollar terms.
Allowing non-humans to participate in the economy has led directly and inevitably to alien domination of the marketplace.
We have been delivered to the parasite.

Americans obsess about British teeth because dental health is an important — if subliminal — status and class signifier in the US. Nice, middle class people with bad teeth are sending distorted signals, which causes anxiety, which leads to anxiety management in the form of tired old jokes.

When I was little, I had such a big gap between my two front teeth that you could fit an additional tooth in there. (I wouldn’t believe this now, but my father has the foresight to take a picture so we have evidence.) I can’t imagine how that would’ve been comfortable throughout my life. We had free dental care in Hungary so my parents took me to an orthodontist to get rid of the gap and the result hasn’t changed since. [pic] The braces I had were what are here, in the U.S., called retainers. I only had to wear them during the night. I don’t have any bad memories of it.

What I never understood is that given free dental care, why so many Hungarians didn’t get their teeth fixed. But I guess the message above is that certain levels of crookedness and gaps doesn’t matter. I don’t know enough about teeth to know to what extent that’s true.

Like Britta, we also went to the dentist together as a class every year when I was in elementary school so even if your parents didn’t take you, you did at least get an annual check-up.

We have a universal ‘welfare state’ here.
When we had a mixed economy we went from world#2 to world#5 in fifteen years.
Today most people can’t get a welfare dentist for the same reasons as in America now.
The government controls how the dentists do business with their ‘National Health’ patients, so the dentists choose not to bother.

As far as the paperwork goes, I don’t know but I seriously doubt that the medicate requires more paperwork than most private insurances; on the contrary, it has an important advantage of having one standard set of forms, as opposed to a bunch of different ones you’ll need for privately insured patient

There are just a couple of alternate standards, and they’re both vastly simpler. You pretty much can’t file Medicare/Medicaid without paying more for the labor involved than you can hope to get for your efforts, if your office isn’t either electronicized or vast. Smaller, older offices are noticeably likelier to not take Medicare. But even electronicized, newer offices have higher operational costs because you have to enter more information, worry more about what they’ll do, and pay alot more for the software, because it’s hard to code.

“We have a universal ‘welfare state’ here.
When we had a mixed economy we went from world#2 to world#5 in fifteen years.
Today most people can’t get a welfare dentist for the same reasons as in America now.
The government controls how the dentists do business with their ‘National Health’ patients, so the dentists choose not to bother.”

Posted by pietr

Um, which country is this? If it’s the UK, there are other explanations.

My sister lived in Maryland for a while. She and I both had braces to make up for the typical wretched American diet (hunter-gatherers have straight teeth, no cavities, and white teeth, once you wipe the film off). She said that folks from Baltimore have awful teeth – white folks, black folks, rich folks, poor folks, doesn’t matter. Something in and around Baltimore wrecks dental health; that, or absolutely no one around Baltimore eats a healthy diet, which I find hard to believe.

– Josh

Sorry, Jon. But still, your argument that Medicaid claims are more labor intensive than all the others – it needs some support; the way you presented it, I’m not buying it, sorry.