Why isn't dental health considered primary medical care?
knowablemagazine.org
knowablemagazine.org
By contrast trying to do something as simple as buying a new medical device for my wife has been a Kafkaesque nightmare with random charges, wrong billing codes, switching companies, fighting insurance, demonstrating need, etc, etc for something I am willing to purchase. The device is also marked up several thousand percent to boot.
Part of the problem with the healthcare discussion is that we need to clarify what we mean by healthcare. When I hear people complain about healthcare they either are complaining about medicine, or hospital stays with crazy and confusing billing processes, and these 2 problems are completely different than each other and require a whole different set of discussions apporaches and solutions, but everyone just talks about "healthcare" with no nuance and it obscures any possible forward progress.
As a final question for pondering how much healthcare does everyone deserve? I think we'd agree it probably isn't reasonable to say a 96 year old woman should get a multimillion dollar experimental cancer treatment that will extend her life by 6 months before dying, on the other hand simply having access to Ibeprofun and Antibiotics means you have access to better medical care than anyone else at any point in history longer than 40 or 50 years ago?
Or, it being too confusing. That's a problem with health insurance, and not with money.
That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.
To your last point, rationing low availability health care is nothing new. Alcoholics can't get liver transplants for example. There's a whole field of bioethics that can surely answer some of those questions.
Why would we expect the incentives inherent in putting health care under the monopolistic control of those who seek political power to be any more favorable than those manifest in the current situation of apparent oligopolistic control by both profit-seekers and political-power-seekers?
Where would this solution leave those who just want to obtain services directly from service providers, without any political or financial middlemen either taking a cut, usurping their agency, or homogenizing the market?
This isn't true. Plenty complaints about long waits for appointments, rushed appointments, not getting proper medicine. My wife recently couldn't get a specific potentially more effective medicine covered (it was in the end) because the insurance company wanted the dr to give her something cheaper.
"Health insurance in my country is so obtuse and convoluted I would rather not put my basic medical needs in there, and rather just pay out of pocket for it separately."
Strange approach.
The common conception of health care has moved beyond just remedying severe illness or injury, but rules and incentives are still calcified around treating it that way.
Insurers like to take all the benefits of the insurance model, and as few of the downsides as possible.
I mean, look at the model of "first you have to meet your deductible, then you have a co-pay which is your 'contribution' to your health care, but also you have to pay coinsurance which is the your portion of your costs after the deductible".
It's a partial amortization scheme for healthcare with a little "benefit of group negotiation" thrown in (when it doesn't actually cost "you" more to go through insurance than out of pocket... "you" because some people, like Martin Shkreli, make money pushing the illusion that somehow insurance companies are magical money fairies who pay providers with something other than the premiums you and I pay, either directly or through an employer...).
Why wouldn't you just do what works very well elsewhere?
The insurance model is broken because of political intervention in the first place. I'm not about to give political institutions de facto monopoly power over the most personal and private aspects of my life just to mitigate a public problem that they created to begin with. I want to cut out the middlemen entirely, not just shift dependence to a different, often less trustworthy, set of middlemen.
Realistically, the price is at or around most people's insurance deductibles.
I am also not impressed with all of these just asking questions it's so complicated asides; there are dozens of existence proofs that demonstrate a diverse set of approaches that more or less solve this problem at the nation level. But that would require a bit of curiosity about how the rest of the world works, I suppose.
The problem with health care/insurance in the US is not because of unanswered economic theories (or lack of half baked econ 101 approaches), rather it's because of hard ideological commitments to maximize rent extraction based on historical contingencies.
Ever wonder why US corporations generally provide health insurance? World War II something something.
This isn't really the whole picture though, is it? I pay £25.80 for a dental check-up thanks to the NHS. If I wanted to do that on a private basis I'd probably be paying double.
https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay...
I live in an EU country where this is not covered by the state health service, so everything is done privately. A filling is around the same price as the NHS, but a crown starts at €500 and dentures are even more.
It could make sense for some categories of routine care to be included in insurance because they reduce risk or are cheap enough to be affordable perks of the insurance product. I just wouldn't call those features insurance.
If you're unconcerned about health insurance compared to health care as such, that's also OK. But the US healthcare system is mostly not a single payer healthcare system, at least not right now.
Insurance works best when risk is spread out over a large pool. In private markets, insurers profit by excluding 'bad risks' which leads inevitably to coverage limitations, exclusions, and high costs for those with the greatest need.
Universal healthcare systems remove this profit motive and market failure.
Everyone contributes, and everyone is covered, regardless of pre-existing conditions. This eliminates adverse selection and allows for better preventative care, ultimately reducing costs and improving overall health outcomes.
Markets are great for some use cases, but disastrous for healthcare.
How does universal healthcare system remove profit motive? Are doctors going to stop seeking profit? Maybe if the government knows exactly how much to pay for a service such that there is no profit, but of course information is decentralized and central planning and price controls fails basically every time it has been tried. Plus profit serves a purpose. If I'm a doctor providing a service and there is more demand than I can handle, naturally I raise my prices, signaling to others that there is profit to be made by providing that service.
> Everyone contributes, and everyone is covered, regardless of pre-existing conditions
Is covered for what and at what price? Presumably you want to reduce overall costs, so total reimbursements will be less. So naturally with a lower price you'll have fewer providers willing to provide that service, which means there will necessarily be a shortage. And now you have to worry about rationing
Because in a system with universal care, we would still have doctors who are compensated for their labor and expertise, but we wouldn't need the rent-seeking insurance corporation, or its officers, or its shareholders, all to prevent people from receiving care.
How much more care could be provided, for the same cost, without all that waste, fraud, abuse and economic rent?
I mean, I pay plenty for health care but I never use it. I'd be much more interested in buying lots of physicians. Pampered empathic physicians.
But I do want annual speeches from them. A website full of them.
I truly don't understand how we have many successful and thriving examples of publicly funded services, yet somehow healthcare - which we all equally need, and which is equally a backbone of a healthy society - is somehow unique in needing profit incentives to function.
The free-market theory only applies to products which you have a choice to engage with, and which are not essential to life and the basic productivity of all society.
Private police patrolling is often far more controversial than all the healthcare debate combined.
https://nl-m-wikipedia-org.translate.goog/wiki/Ziekenfonds_(...
We had a lot of.. shall we say.. doctoring with the system in the Netherlands.
Towards the end of the page:
> Negotiations between health insurance funds and doctors about health insurance fund rates for medical care were generally quite difficult and led to intense conflicts on a number of occasions.
Followed by a good example of "debatable":
> The lower income from the health insurance practice was compensated by most physicians by higher rates for private patients.
Could possibly be true but the opposite is definitely not true. If I get more money for bananas I wont sell apples for less.
If you really want to make health care affordable, increase the supply of everything and cut the red tape. The cost issue is mostly due to a lack of supply rather than an issue with who pays. Of course well-financed entities like governments and insurance companies are capable of distorting prices. But if there were enough clinics, doctors, and supplies, we would all be able to afford basic health care even on a meager income.
See this for example https://www.statista.com/statistics/1109036/satisfaction-hea...
Singapore has low costs and high satisfaction. Maybe copy that one?
But anyway Belgium is also on the list and other places. I did mention Singapore to a friend in the UK who works with the NHS and he said it wouldn't work here because Singaporeans are responsible and look after their health while Brits don't. Not sure about that one.
It seems to me that "It makes sense to include them with insurance but I wouldn't call them insurance" is needlessly pedantic
Maybe insurance isn't the right word for what our medical plans are, but this feels like some serious mental gymnastics to avoid seeing what obviously is.
https://youtube.com/watch?v=4d_FvgQ1csE&pp=ygUgcHJlc2lkZW50I...
How is this acceptable in academic research? Nobody is citing the primary source and everybody is citing interpretations of some source that I can’t find the text of (probably because I’m on mobile).
tl;dr your citation is worthless through no fault of your own.
While I agree that dentistry absolutely has an overtreatment problem, there's enough evidence that some procedures result in pain relief at a minimum that we don't need to insist on double-blind trials -- and in fact performing such trials would be unethical.
But this is simply untrue and it undermines the rest of your point. The actual satirical statement is supposed to be about clinical trials (research studies involving humans), not validated research in general.
The study linked is not simply about clinical trials but rather than dentistry lacks validated research in general.
But seriously you have inferred that parachutes are important from other high quality evidence… This is exactly what dentists are doing. Then they get criticised because the study was not double blind for the exact treatment they recommended.
Dentists are criticized because there are clinical trials about the effectiveness of dental cleanings and they do not support the hypothesis that dental cleanings have a beneficial effect on dental health.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
It does not compare cleaning with never cleaning. It is not evidence that you should never do a dental clean. It does not refute the idea that cleanings are beneficial.
I'm not here to tell you personally what you should or shouldn't do. By all means keep doing dental cleanings, continue seeing your chiropractor, routinely checkup with your naturopath or guru, or whoever else you want to pay money to for whatever reason you want.
I'm just pointing out the objective fact that there is no evidence that doing so will provides any observable health benefit. It might benefit you psychologically, it might encourage you to take better care of your teeth if you see your dentist regularly, who knows... but as far as the science goes, well there just is nothing to substantiate dental cleaning.
https://www.researchgate.net/publication/230768070_Is_the_Ev...
https://www.cadth.ca/sites/default/files/pdf/htis/oct-2013/R...
https://www.ncbi.nlm.nih.gov/books/NBK554695/
https://www.cochrane.org/news/routine-dental-care-does-evide...
But if the benefits are subtle or borderline, then it’s an interesting ethical dilemma. Which is the least unethical: withholding a potentially-beneficial treatment from a control group, or giving a potentially-non-beneficial treatment to everyone?
Next time maybe try engaging with the actual topic of the conversation? Like how some people are more or less prone to cavities and why that might be biologically or something? Obviously we all know that dentists are checking for cavities and people should go. I had an irrational fear of going to the dentist and opened about up about that here and all you can think to do is berate a point everyone here already knows?
I'm saying you not having cavities has no bearing on the overall benefit of people in general going to the dentist to get checked more often than every 10 years.
Again, it's like someone smoking their whole life and living to 100 then saying "some people can live to 100 while smoking all the time". You don't know until it has already happened, it doesn't help anyone.
My point is that I find it interesting that some people get cavities despite going to the dentist regularly and some people never go to the dentist and never get cavities, that’s all. Could there be variables beyond genetics at play here? I don’t know, which is why I’m interested.
I must have had some pretty bad halitosis with that calcified plaque because now I’m not habituated to the smell. For those in my family that are clearly not flossing and have shit breath i thought about buying them dental kits and floss for Christmas stocking stuffers. My SO said no and it’s their wives and dentists who should tell them. I kinda disagree but I’ll leave it alone. Someone had to tell me - what if no one ever tells them their breath is horrid because of the calcified plaque? They’ll just wander through life like that?
Be helpful.
And now I just do it every morning and its just soft plaque rather than calced.
If you're eating healthy and have good hygiene, doctors ain't gonna help whatsoever unless you're unlucky and get a rare disease that they can actually diagnose and treat correctly. The likelihood of that is probably around 0.0%, rounded.
The average person drinks soda, eats lots of sugar, drinks alcohol etc. That adds up over the years. especially soda in the context of dental care, as that's an acid and destroys the enamel over the years. once that's damaged, things get worse.
Kinda relevant: is the 92 in your username your birth year? If it is, you not having any issues is to be expected. Most people develop their Dental issues in their late 30 and later
When I was there, I noticed people brushing teeth after lunch. This happens even at corporate offices -- the restrooms would be full of people brushing and flossing after meals. People brought toothbrushes to work. There was even a floss (fio dental) dispenser.
We should note that dentists and opthomalogists do not typically operate from a hospital setting, at least not in the early (1920-1950) era.
Over time it was spun out of hospitals and extended to more medical procedures. The tax advantage of having employers pay for coverage began to dominate the market and has led to the current state of the medical marketplace. But the original dichotomy remains. "Health" insurance covers things that doctors do, and mostly those things that happen in hospital settings.
There is an interesting article [1] that has some of the history of group health coverage which I found just now.
[1] https://www.peoplekeep.com/blog/the-complete-history-of-empl...
Dentistry started more as a kind of "mechanic"-type profession of rather crude surgery (of course, all surgery was quite crude before modern times), and was often a sideline of other professions (e.g. dentures were made by jewelers and other types of craftspeople).
By the time dentistry started to turn into a serious medical discipline in the 1800s, the existing branches of medicine didn't want anything to do with it. So dentists founded their own medical schools, developed their own licensing boards, and so on. By the early 1900s, dentists were so used to being separate that they actually actively lobbied against any attempt at unifying medicine and dentistry.
There's a good article in The Atlantic about it: "Why Dentistry Is Separate From Medicine" [1].
That way politicians wont have to bring up the unpopular subject.
So how do you integrate that into the health care system as a whole? Do you just continue having people see the dentist every year and get their teeth cleaned to continue the tradition so that dentists can continue to get paid? Do you eliminate it and then put a large number of dentists out of business?
A great deal of common dental care as a whole is not actually based on any kind of science or research. Certainly some of it is legitimate and the article points out the few cases where there is a strong connection, but that makes up an absolute tiny minority of dentistry as a profession in terms of the money.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Anecdotally - I have issues with receding gums - and teeth cleaning (even though I hate it and only go once every 3 years or so) seems to be one way to quickly alleviate it for a while. For me there appears to be some benefit at least to going regularly if one does have dental problems.
I can't speak to your particular medical condition, but I can say I know people who say the exact same thing about acupuncture; they absolutely swear that it helps treat their pain and they are sincere in their belief just as I am sure you are sincere about your belief.
Thankfully science is not about sincerity in one's own beliefs.
I've probably went to a dentist 30 times or so, whereas I've only been to all other kinds of health care 5-10 times over the same time range, combined. So putting them in the same basket would be untenable for one or the other. Like if you had to go to your car dealership for gas refill. Or if you expected your warranty to also cover gas.
Another disastrous area is eyesight, but since you cannot really fix it, you go to doctors about it just as much.
I've also been living for almost 40 years now and the science has yield surprisingly few fruit in those two areas.
I've probably went to a dentist 30 times or so, whereas I've only been to all other kinds of health care 5-10 times over the same time range, combined. So putting them in the same basket would be untenable for one or the other.
How is it untenable?
Not saying I agree with the policy.
The ER will at least give you antibiotics for an abcess. But few can afford to actually deal with it.
So, yes, even outside of emergency situations, lots of people die because they cannot/won't see a dentist.
In short it’s a scam industry with a sliver of good health mixed in. It’s definitely not primary medical care.