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"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.

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.

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)

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.

some people dont have space for wisdom teeth, and in such cases they need to be removed - whether it can bedone simply with some freezing or some more complex surgery depends..... but uf you dont haveenoughspace, as many dont, they gotta come out.

I'd go with a business rational over the theory of distributive just over lifespans. It's an adverse-selection problem. Wisdom-tooth extraction is usually not an emergency (Nick's case excepted!)-- they have to come out sooner or later, but often you've got some time. And it's a big cost compared to most dental work. If the insurer covered all or most of it, you'd have people signing up for dental coverage, getting their teeth pulled, and dropping out.

It's not always a 50% co-pay. That will vary by state and by plan. I have pretty cheap & awful dental insurance, but wisdom teeth extraction was 100% covered. I think my only cost was the copay for anesthesia.

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!

My wisdom teeth actually fit in my mouth. Because I took care of them (and the rest of my teeth) as they started growing out, I get to keep them.

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

Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit. Case in point, I (25-year old guy) had a wisdom tooth which grew sideways (into the next tooth) and _would_ have destroyed the next tooth and caused an infection like the one linked in the article. I have a second one which might do the same.

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

> Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit.

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.

I'm missing two upper teeth [0], which resulted in my having enough room in my mouth for my upper wisdom teeth to fit comfortably. It's evidently of genetic origin in my case, as I have relatives who are missing the same teeth, which I think from that source are called the upper lateral incisors. Were I not missing those teeth I expect I'd have needed the upper wisdom teeth removed to make room.

(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...

Interesting. I know of at least two other people with that condition who were missing a number of adult teeth that never came in. Though, I think their example is somewhat more extreme (and according to Wikipedia, I guess it would be classified as oligodontia), because at least one of them required extensive dental surgery for implants since they quite literally lacked 6+ (maybe more?) teeth.

> (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...

"Remember, humans didn't usually live to become 50 years old."

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

I think this is the point of contention...

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

Unless 'proper dental hygiene' includes putting stones in your mouth and trying to make it bigger.

To defend myself here (a day later), I was not assigning the causality in that direction. The "Because I took care of them" clause goes with the "I get to keep them", as in "I made sure to clean them and not let them get cavities, so there aren't any problems with them staying around". I thought the English was clear enough as I wrote it, but I guess parse errors are more common than I thought.

"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.

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

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.

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.

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.