Dentistry In Socialized Medicine
Posted by WhiteCoat on May 31, 2008
Was perusing the WordPress Dashboard and saw this post.
This is pathetic.
This poor guy (the picture at the right is not his) has had dental problems for two and a half years and has been getting the runaround about having his teeth fixed. 823 days and counting! He’s even drained his own abscesses twice using veterinary equipment.
3 months to get an appointment for a dentist when an abscess had spread to a second tooth
7 months to get an appointment for a dental specialist who didn’t treat him and then turfed him back to his initial dentist
5 months and counting for a follow up appointment with the dentist
But hey – at least the care is free, right?
When you can get it, that is.
This is the kind of healthcare system we want in the US?
Quality medical care, quick medical care, free medical care. Pick any two.
Stonehead said
Actually, the treatment is not free. You still have to pay a fee, but it’s much less than the full amount.
You also failed to mention the private option. I could go private, as people do in the US, but it would cost at least £2,000 (about US$4,000) for private root canal treatment and possibly as much as £2,700 (US$5,400). As that’s about a third of my yearly income or seven per cent of our combined household income (after tax), private is not an option.
I don’t have much time for either the US or the UK system. Both ensure that only the most affluent in society get the best dental care, with middle income earners just about getting by, and the least affluent being ignored. (And the UK system is not really socialized dental care—it’s more a bureaucracy of number juggling, target obsessed apparatchiks with no interest in socialism, dentistry or care.)
This is just amazing to me.
It creates a system of “haves” and “have nots” very similar to the way the system works in the US right now.
A root canal with a crown in my hometown right now costs about $1000 to $1200.
How many people actually pay $4,000 to $5,400 for a root canal? How many private dentists can stay afloat by charging that much? It would seem if the dentists halved their price, they would more than make up for the lost profit in increased volume.
Davey said
That picture belongs under “Ewwwwwwwwwwwwwwwwwwwwww Number 3″
jvalways said
oh, man. you really should have put up a warning before you showed that photo. i’ve got a pretty strong stomach, but anything related to dentistry makes me ill.
idahokat said
Ewwwwww #1 is where that picture belongs. Is that gangrene meth-mouth? Yech!!
How to prevent meth use « Kat’s sKratch pad said
[...] (one of devastating side effects of it). Today’s rant on meth struck me after reading Dr. WhiteCoat’s entry on Denstistry and Socialized [...]
Teresa said
I could go private, as people do in the US, but it would cost at least £2,000 (about US$4,000) for private root canal treatment and possibly as much as £2,700 (US$5,400). As that’s about a third of my yearly income or seven per cent of our combined household income (after tax), private is not an option. –Stonehead
I don’t understand this. I made about $21,000 last year. In the last 6 months, I’ve spent over $7000 in health care (cost to taxpayers, zero compared to anyone else). I have a private insurance policy, not a group policy. I do not get insurance through work. This is the most expensive kind of insurance there is. I do not live with anyone, so total household income is what I bring in alone. I do not get subsidies of any kind from the government or anyone else, for that matter. I’m even too young for the senior discount at McDonald’s, even if I did drink coffee or whatever it is they give seniors at a discount. I live only on the money I’ve earned myself. I admit to a very modest lifestyle, but I don’t feel at all deprived.
In America, if you can itemize your deductions, you can only deduct medical/dental expenses that are over 7.5% of your income. That means the first 7.5% of your income worth of medical/dental expenses are on you. I deduct a couple of thousand in medical/dental expenses EVERY YEAR. Which means I routinely spend more than 7.5% of my income on medical and dental expenses.
I don’t have much time for either the US or the UK system. Both ensure that only the most affluent in society get the best dental care, with middle income earners just about getting by, and the least affluent being ignored.
I suppose we could argue this point, but my income hardly qualifies me as affluent. Yet I have found a way to get the best medical care in the world. Ditto dental care.
Oh, yeah, and I have no dental insurance. I go at least twice a year, and pay full price for all of the dental work I have done. I have never asked my dentist for a discount. He is a treasure, and I am happy to pay his bill.
seven per cent of our combined household income (after tax), private is not an option.
Still flabbergasted at this. Wow. Perspective is everything, I suppose. Does your household pay more than 7% for housing costs, and if so, do you feel that needs to be subsidized in order for you to afford it?
Quality medical care, quick medical care, free medical care. Pick any two.
To Dr. WhiteCoat: I pick quality and quick as my two choices. Is there any such thing as free to all? There may be free to some, but never to all. Someone has to pay for it. I’m no longer pulling the wagon, but I never got in to ride, either, in deference to all the pullers, one of which I used to be.
I give you a lot of credit for managing your finances. I don’t have quite as much control over mine with the size of our immediate and extended families, but wow!
Part of the problem with the medical system right now is that due to insurance and third party payors, people expect that it should be free. Look at what happened with gas prices. Everyone expected that gas should cost $2.50/gallon. When the price doubled, everyone was outraged because that price was so outside their expectations. During that time, gas was costing $4.50-$5.00/gallon in Europe.
Medicine will need to go through a similar period of public outrage. Unfortunately, the way that I think things will work out is that there will be a scarcity of physicians, people will desperately need some physicians’ services, and those with the means to do so will pay whatever it takes to get those services. Those without the means to pay will suffer bad outcomes and there will be more public outrage before the new inertia is created.
Regarding “quality and quick” – if that system resulted in a cost of $5400 for a root canal (and presumably even more for other more urgent treatments), is that kind of care sustainable? What happens when someone needs emergency surgery or cardiac cath and doesn’t have the cash?
To answer my own question – that will be the renaissance of the insurance industry: major medical.
The Happy Hospitalist said
Ma? Is that you?
mottsapplesauce said
I’m amazed that gent is still alive. I don’t take mouth/tooth abcesses lightly. A friend of mine had always taken good care of his teeth, but had let one of his wisdom teeth go to the point of abcess, which then tunneled up into his brain, requiring major surgery. All of which could have been avoided by seeing a dentist.
Davey you took the words right out my mouth. No pun intended.
Ian Furst said
OK Stonehead (whatever your real name is — I’ll call you Deborah) you can’t have it both ways. In Scotland you have both options. Low cost care and you can get whatever you want done (eg root canal treatment) at the expense of access or high cost care in a timely fashion. White Coat — you’ve already got the system in the US. 85% of people have private coverage and 15% don’t (give or take). Those without coverage usually opt to have the tooth out in a county hospital. In Canada dentistry is private too with public coverage for those in financial distress. If you’re under the public system it only covers the basics (and root canal is not considered basic). I suspect Stonehead wants root canal done at no cost to him and that’s what is causing delay.
The more appropriate comparison to general health care are the systems where it is not two tier. Do the wait times in Canada compare to the wait times in the US? Depends on the problem and location. The bigger difference is that when wait times grow in the US — people have the option to throw more money at it and the problem changes quickly. In socialized medicine, the money has to flow through taxes and government which is VERY slow. BTW I see that mouth pictured at least once a week.
http://www.waittimes.blogspot.com
The problem is that those who are willing to pay are priced out of the market.
There needs to be a happy medium where lower income patients can pay *something* in order to get a service in less time than 3 years. As Stonehead has things now, he is fighting a war of attrition against a bureaucracy and he is going to lose no matter what.
We could get into a philosophical discussion about whether health care is/should be a right, but the bottom line is that because of third party payors, free markets aren’t able to dictate prices in our system right now. Very few people know the true “value” of medical services.
No way a root canal should cost $5400. I don’t care who is doing it or who is getting it.
Why should an average laborer spend a month’s pay for a GI doc to stick a camera up his nether regions for 30 minutes?
Why should breast implants cost less than dental restoration?
This is crazy.
Emma said
My Grandmother and sister pay to go private. It’s expensive but both of them go religiously every 6 months. I live here in the US and I have dental insurance, which covers the basics like cleaning check ups, x-rays etc. There are many dentists in the Uk who no longer take NHS patients so people are having no other choice but to pay.
anonymous said
My husband is a dentist & long ago (over 25 years ago) gave up on Medicaid for dental care. Its just too much paperwork & hassle. No private practice dentist in our county provides it either. For those adults who have this as the only option – they go to the county hospital who have new dentists provide hourly services Fri,Sat & Sun. The tooth is pulled or not – their choice – no restorative!!!! There may be a few “mill” dentists around, but no one refers to them & their care is no better than the county hospital.
For children, the county dentists have chosen to provide dental care at no cost. Each general, pedo, peri & oral surgeon will see a child at no cost & provide care (composite fillings – no amalgams or crowns). No ortho though.
Thats just the way it is – dentists have chose to just say no to the “system”.
Somehow, people get by or don’t. But, dentistry has always fluctuated with the economy. When its good & they have insurance – they go. When its not & they don’t – they delay traeatment. Its been that way for 30 years – whether you have insurance or not. Ask around – see how long your friends who work in other industries who’ve been laid off have gone without dental insurance & therefore care for months & even years. Its astounding!
The good news – no hassle from the government – just private insurance. But, he can choose to participate or not.
Disciple of "Bob" said
Once upon a time, I had a recurring nightmare wherein I would spot a very long and coarse out-of-place hair growing on my forearm. I would pull it out, only to find that the “hair” was actually the breathing apparatus of a worm about 10″ long and as thick as a pencil, with the texture of a rat’s tail. In the dream, my arm was left with permanent swiss cheese holes, through which I could see a huge colony of these worms living inside my arm. Now I’m probably going to have a similar bout of jaw-rot dreams, and if in the the foreseeable future I should have a headache, I’m going to have a hard time convincing myself that it’s not a rip-roaring bone infection boring huge holes all through my skull.
I don’t understand how anyone, trained professional or not, can look at that and not run away in horror, much less set about trying to fix it.
You are a riot.
Like pulling out one of the teeth and having something attached to the root?
I think you need to write a book.
Teresa said
Dr. WhiteCoat, please make another post soon. I don’t think I can stand to see that picture one more time at the top of your page.
Jenny said
No, it certainly isn’t. That is horrible. Poor soul … I cannot imagine the pain he’s suffered.
Nurse K said
…and the least affluent being ignored.
We have a 20-page packet that we give out where each page has 1-5 names of sliding fee dental clinics which are reasonably priced. There are now some dental clinics with “walk-in” pay-in-cash services in addition to an insurance-based fee structure where the prices are clearly posted. When someone says they have an appointment at one of these very reduced-priced clinics, I ask them how long it will take to be seen, and it’s rarely over one month. These are full-service dental clinics. One of my friends used one, for instance, to have a crown put on and have a pesky wisdom tooth removed.
As a last resort, the university offers absolutely free dental care by students supervised by an instructor and the homeless shelter down the street has a twice-monthly absolutely free dental clinic. Other large homeless shelters offer similar services.
So saying the least affluent are ignored is not true, at least around here. Ergo, the homeless do better in my city than the average Joe in the UK who can’t afford private pay.
You have one heck of a system in your town. Only a couple dentists available in the metro area where I work and no dentist accepts public aid within 50 miles of the rural place where I moonlight.
ERnursey said
Dear God! That is the worst mouth I’ve ever seen – I’ll be flossing for the next hour or so, right after i take some Compazine.
BBC: Rate of Dental Abscess Hospitalizations Double « The Dental Implant Blog said
[...] about his wait for treatment of his abscess – he claims he’s been waiting for over 2 years. White Coat Rants – one of my favorite health blogs – posted about it but put up a picture that was just nauseating. [...]
BBC: Rate of Dental Abscess Hospitalizations Double « The Dental Implant Blog said
[...] about his wait for treatment of his abscess – he claims he’s been waiting for over 2 years. White Coat Rants – one of my favorite health blogs – posted about it but put up a picture that was just nauseating. [...]
BBC: Rate of Dental Abscess Hospitalizations Double « The Dental Implant Blog said
[...] about his wait for treatment of his abscess – he claims he’s been waiting for over 2 years. White Coat Rants – one of my favorite health blogs – posted about it but put up a picture that was just nauseating. [...]
MedicMatthew said
I have to thank you oh so much for posting that photo. I just threw up in my mouth a little bit.
Nurse K said
You have one heck of a system in your town.
Yeah. I know. People where you live could probably find a similar infrastructure if they drove into The Big City…wherever it is that there are (1) dental colleges and (2) indigents. I’m not sure how these freestanding sliding-fee clinics stay in business, but I suspect there has to be subsidies/govt grants involved. Notably, my state has a relatively high rate of insured people, so there is a smaller pool of people needing these type of services vs. other areas of the country.
ACDDS said
I look at mouths nearly as bad as these all the time. I practice 2 days a week at a Medicaid clinic. I can’t even pay my student loans from dental school if I worked there full time. I drive a 10 year old car, have no TV or any cable service, and I am very careful with my money. Most of my patients have neglected their oral health for a long time due to a combination of reasons – drugs, soda, smoking, financial (although they all drive nicer cars than I do AND have nice TVs, cable etc.) The patient needs to first take an invested interest in their health care at home before I feel that my tax dollars should pay for their disregard for their own health.
mottsapplesauce said
Nurse K: our local University has a similar program, in fact many times the students are desperate to find clients & usually go hunting on campus.
ACDDS: You are so right. Everyone has their own set of priorities.
SeaSpray said
I feel badly for people who don’t have the money for dental care.
Teresa said
I give you a lot of credit for managing your finances. I don’t have quite as much control over mine with the size of our immediate and extended families, but wow!
Thanks for the kind comments. I have a lot of practice at living on very little money. At times in my life I’ve been forced to “live poor.” But I also have honed my money management skills in the non-lean times. It is easier with practice, and it is easier if you live alone or only with like-minded people.
In order to live this way, I have had to become an expert in personal finance. It’s not a topic I would normally be attracted to, but my choice to live frugally demands such expertise.
Part of the problem with the medical system right now is that due to insurance and third party payors, people expect that it should be free.
Yep. We’ve made a Faustian bargain, and a collective one, at that. I really can’t afford to pay for health care “the right way” (the way my financial expertise tells me is the right way) because of all of the rest of the people out there DRIVING UP THE COST of care with their bad decisions, particularly insurance.
We need to get health insurance out of the hands of employers and government. We need to re-educate people that insurance is for CATASTROPHIC events, not every snotty nose your child has.
Medicine will need to go through a similar period of public outrage. Unfortunately, the way that I think things will work out is that there will be a scarcity of physicians, people will desperately need some physicians’ services, and those with the means to do so will pay whatever it takes to get those services.
I do worry about that. I’m just hoping that it’s far off enough that I’ll be ready for comfort care only by then.
Those without the means to pay will suffer bad outcomes and there will be more public outrage before the new inertia is created.
Well, I am psychologically prepared to cope with that, if I have to. Health care is not a right. I get great medical care right now, but I also know I could live with less medical care if I had to.
Regarding “quality and quick” – if that system resulted in a cost of $5400 for a root canal (and presumably even more for other more urgent treatments), is that kind of care sustainable?
Root canals only need to cost $5400 in a system controlled by insurance and the legal profession.
What happens when someone needs emergency surgery or cardiac cath and doesn’t have the cash?
That’s what a catastrophic insurance policy is for, love. That’s the way insurance is SUPPOSED to behave. You can get home insurance on a $500,000 home for less than a $1000 per year. Now imagine that the homeowner starts expecting the insurance policy to pick up the tab for every repair, for that $40 part for the washer, etc. Now what’s it gonna cost? You have house insurance to pay for something that would break you financially, not for routine stuff. That’s part of the cost of living.
Likewise, a flu shot is part of the cost of living. Seeing the doctor to control HTN is part of the cost of living. A broken bone happens to lots of people, but who can afford it now? Shouldn’t be that expensive.
Take a look at what it costs to treat your dog or cat for the similar things that humans go through. Surgery to spay or neuter can be as low as $100 for everything. Cancer surgery and subsequent chemotherapy might be a few hundred. Guess what. Insurance is not widely used by pet owners, and because pets are considered property, you can’t really sue for malpractice. And the government doesn’t play tax games with veterinary medicine costs. Many medicines prescribed for your pet are also used for humans–same exact stuff, but it’s almost always more expensive to get it at the human pharmacy than at the vet’s office.
Dark said
I awoke yesterday morning to find a Dental Abscess on my lower right 2nd molar. When I was young I had very healthy teeth while only brushing once a day, lucky me. Unfortunately when I got into my teens the one a day I was doing didnt surfice. Luckily due to being in full time education, I got 2 free fillings, one on the problem tooth and one on the one next door.
The tooth next door lost the filling when I was 17, I had it replaced shortly after. My tooth continued to decay around the filling and eventually snapped leaving an open-ish stubb. This affected the tooth next to it by harvesting bacteria. The effected tooth now has a section, albeit a very small one, missing. That has caused my Abscess.
I take decent care of my teeth these days, being 22, and I am unhappy about it, but there is not much I can do.
I now have the problem of finding an NHS dentist since I am out of work due to illness. I am a well educated man from a working class family and have worked pretty much since I was 14. I now have no options and no way in hell to pay for private. I have been reading up and realised if I dont get a root canal or it lanced then it can spread to other teeth and even further.
I am not amused, I pay my taxes and have worked damn hard all my life and now I am forced to either get the tooth removed or find a dentist. To be quite honest, im in that much pain at the moment I dont care which. Trying to do either is not going to be easy though. The fact that dentists have cut their NHS patients is in my opinion appaling, we all need to earn money, but that is just greed, plain and simple.
The worst thing is, I should be cleared to work by september, but I am stuck in the age old fight of needing money to sort this out so I will be able to work.
Dan Marsalek DDS said
I’m a retired dentist and have to admit that the photos shows a mouth worse than I have ever seen. It shows total neglect. The decay and periodontal disease is rampant.
Question? Is that patient so poor that he can’t afford a toothbrush that would minimize his fetid, offensive breath? Has he no self esteem or does he merely respond to pain and infection?
Unless it was a matter of roaring, aggressive infection, I would hand him a toothbrush and see him after a week of intensive home care. Otherwise—-out the door!