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Individual dental plans typically aren't available. Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typ

Individual dental plans typically aren't available. Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care. 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.

sliverstorm 15y ago
Amen! The concept that your own health is somebody else's job to take care of & protect has always seemed strange to me.
- tptacek 15y ago
  This is probably true for dental, for a lot of reasons, including the routinization of dental care, the degree to which dental expenses are preventable, the fact that fewer people have dental insurance than health insurance (and so the market for dental care is less distorted), and the extent to which dental care can be cosmetic. 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.
  - stretchwithme 15y ago
    There was single payer before the tax code subsidy for insurance came along. It was called "cash". 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.
  - _delirium 15y ago
    Health also has significant variance in outcomes, much more than the variance in dental costs, so it makes sense to pool risk. However, the fact that events aren't uncorrelated like a lightning strike makes it hard to deal with as an "insurance", the usual risk-pooling strategy, because in many cases the event has already happened, so no sane insurer would insure against it (how is it insurance if it has an 100% chance of occurring?). 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.
    - deleted 15y ago
      [deleted]
      - _delirium 15y ago
        Sure, people can't be the same, but I see paying for major healthcare problems as just one of the basic "civilized society" baselines. I mean, in most of those other cases you have other choices: can't be an air force pilot, do something else. And we do make some baseline effort to ensure that you have some ability to choose a career, by providing free public education. But if you have a heart that doesn't work without medical treatment, you don't have an alternative to "get medical treatment". 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.
bgruber 15y ago
"Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care." 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.
- rkischuk 15y ago
  I said "not always". Although it seems possible that scheduled wisdom tooth extraction may have been possible with proper care, regular x-rays, etc, that's not really the point. 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.
  - bgruber 15y ago
    I said "not always". 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)
    - rkischuk 15y ago
      Sure, you can micro-parse the language, and yes, I mean it's at the 50% co-pay or whatever. 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.
mgkimsal 15y ago
"obvious step of making individually purchased health insurance tax-deductible long ago." 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.

sliverstorm 15y ago

Amen! The concept that your own health is somebody else's job to take care of & protect has always seemed strange to me.

tptacek 15y ago
This is probably true for dental, for a lot of reasons, including the routinization of dental care, the degree to which dental expenses are preventable, the fact that fewer people have dental insurance than health insurance (and so the market for dental care is less distorted), and the extent to which dental care can be cosmetic. 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.
- stretchwithme 15y ago
  There was single payer before the tax code subsidy for insurance came along. It was called "cash". 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.
- _delirium 15y ago
  Health also has significant variance in outcomes, much more than the variance in dental costs, so it makes sense to pool risk. However, the fact that events aren't uncorrelated like a lightning strike makes it hard to deal with as an "insurance", the usual risk-pooling strategy, because in many cases the event has already happened, so no sane insurer would insure against it (how is it insurance if it has an 100% chance of occurring?). 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.
  - deleted 15y ago
    [deleted]
    - _delirium 15y ago
      Sure, people can't be the same, but I see paying for major healthcare problems as just one of the basic "civilized society" baselines. I mean, in most of those other cases you have other choices: can't be an air force pilot, do something else. And we do make some baseline effort to ensure that you have some ability to choose a career, by providing free public education. But if you have a heart that doesn't work without medical treatment, you don't have an alternative to "get medical treatment". 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.

bgruber 15y ago

"Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care." 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.

rkischuk 15y ago
I said "not always". Although it seems possible that scheduled wisdom tooth extraction may have been possible with proper care, regular x-rays, etc, that's not really the point. 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.
- bgruber 15y ago
  I said "not always". 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)
  - rkischuk 15y ago
    Sure, you can micro-parse the language, and yes, I mean it's at the 50% co-pay or whatever. 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.

mgkimsal 15y ago

"obvious step of making individually purchased health insurance tax-deductible long ago." 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.