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Comment by chimeracoder | Hacker News Reader

> If anything it will be more expensive because of the added bureaucracy and separation of who pays from who benefits.

Yes, real insurance (like car insurance or renter's insurance) will always have an expected value that is negative - the expected sum of all future payouts must be less than the sum of all future premiums paid. So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.

Not all dental and vision benefits are completely predictable and routine, but the overwhelming majority of covered benefits are, unlike health insurance (which isn't really "insurance", despite the fact that we use the term).

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>> So insuring against completely predictable events is never worth it unless someone else pays for it, and even then it's less efficient than if they gave you the extra money directly.

It's worth it if the government guarantees it. Dental insurance might not be a good business to be in, but nevertheless people need it. It's a market failure, and it needs government intervention.

I don't understand why you think dental EDIT: care is a market failure. There are dentists people can go to and get care. Pricing is mostly not affected by if you have insurance or not. (Most dentists will just charge you if their rates exceed what insurance pays.)

If you're arguing that "someone" ought to pay for dental care that's a different matter that doesn't really have anything to do with insurance per se.

ADDED: And one actually gets into cost discussions about things like crowns and alternative treatments with dentists. It actually seems like a good model of how healthcare spending should work. Yeah, I have insurance that pays some but thats orthogonal to the cost discussion I have with my dentist.

It's a market failure if people are suffering due to being unable to afford proper care. It's possible that the blame lies elsewhere than the insurers themselves. Maybe dentists charge too much. But the market isn't providing what people need. The ideal solution would be single-payer, but expanding Obamacare and Medicaid to cover adequate dental services would be a big leap forward.

The true problem you're identifying is poverty. Dental care isn't outrageously expensive. It doesn't have huge margins or vast inefficiency. The reason people can't afford it is because they're poor.

No bureaucratic solution involving government-subsidized dental services is going to produce a better outcome than taking the same money and giving it to those people in cash.

The margins are healthy enough that many dentists work 4 days a week while earning a fantastic living.

Salary isn't margin, it's cost. You have to pay the market rate to convince your dentist to be a dentist instead of a psychiatrist or lawyer or bank manager.

What are you proposing, price controls? Then what do you do when your dentist quits to become a real estate broker?

I'm not proposing anything. Just stating that dentists make good money on nice hours.

If I was proposing anything, it'd be to make it easier to become a dentist.

That would certainly make more sense than any kind of public dentistry service, though it's not clear there is a lot of room for improvement there. What makes becoming a dentist hard is, basically, medical school. It's possible there is some low hanging fruit there, but a lot of that hardness is intrinsic.

In the US dentistry is a separate track.

Many more people would like to become dentists than are accepted into dental schools.

http://www.adea.org/publications/Pages/2009-Applicants-and-E...

Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

> Of course having standards is good for patient outcomes. That said, I bet lots and lots (and lots and lots) of the rejected applicants would be fine dentists.

Would you bet your root canal on it?

The fact that there are more people who would like to do something than there are people who are capable of meeting the performance qualifications for it isn't an inherent problem. Only 0.6% of Navy recruits end up becoming SEALs despite 50% of recruits expressing interest. I'm sure there are many, many Navy sailors who would be fine SEALs, but that's neither here nor there.

Unless you're referencing specific evidence that the qualifications are systematically too strict[0], then it doesn't mean much to say that there are rejected applicants who would be fine dentists. And to be blunt, I think it'd be easier to make the case that they're not strict enough.

[0] The working hours and revenue of dentistry practices are not evidence of this

If the marginal applicants rejected from dental school wouldn't make good dentists, then sure, it's likely the case that the marginal graduates aren't good dentists.

It's not really the case that we learn anything about the capabilities of applicants from the rejection, the number of people admitted to dental schools isn't adjusted to account for particularly good or particularly bad applicant classes.

Maybe the occupational licensing is too onerous? I'm sure that you can get cheaper dental treatment abroad.

Yeah. Pretty much all the same arguments could be applied to automobile purchase and maintenance, something that many people require to get from where they live to where they work. It doesn't mean that we need to have a government program specifically to cover cars.

There are actually already public dental clinics in many cases with reduced fees for people below certain income levels.

The problem is that poor people need cash for lots of things. If you're poor enough that you can't go to the dentist, you're poor enough to be hurting in any number of ways. If we give you $500 and say, "now this is for the dentist -- save it in case you need it", they're quite rightly going to tell you to fuck off and go buy food and gas for the car to get to work. And then when they need a dentist six months later, we're right back where we started, except with the added shittiness of a bunch of upper middle class conservatives preaching about how they "wasted" the money.

> The problem is that poor people need cash for lots of things.

That isn't the problem, it's the reason why giving them cash is better. Because if they can't afford to put gas in their car to get to work, using that money will keep them from borrowing it from the credit card company. And then in six months they'll still have $500 less credit card debt plus having not paid 25% APR for six months.

I'm not arguing that they're wrong. I'm arguing that it isn't in any way a solution to the problem of paying for dental care.

How isn't it? They can get the dental care already, the problem is that doing so will put them in debt. Giving them money cancels the debt, which solves the original "problem".

The only way it doesn't pay for dental care is if they don't buy dental care at all because they need something else more. But if they're correct to do that because the other things really are more important, what kind of idiots are we to think we should be finding a way to redirect the money back to dental care?

The only real solution then is to get them enough money that they can pay for the dental care and the more important things.

> Pricing is mostly not affected by if you have insurance or not.

Based on the bill breakdown I get from my dentist, it appears negotiated rates are a thing here too. I regularly see a total price, an insurance discount, and paid-by-insurance amount. The 'discount' ranges from 10-50% depending on the service.

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