Americans spent $95.2 billion on dental treatment in 2007, or $315 per person. This is barely 4.3 percent of the whole $2.2 trillion ($7,421 per capita) spend on health care. It’s no surprise, therefore, that when politicians crunch figures, dentistry and dental expenditures are often disregarded.
Afraid of having to carry their wallets to the dentist, most middle-class Americans are aware of the expense of dental treatment. Between 1998 and 2008, the cost of dental procedures grew faster than the cost of medical care, well above the normal rate of inflation. (Medical-care costs have risen somewhat faster than dental prices during the last 30 years.)
A comparison of the CPI with dental and medical indices is shown below.) Dental services account for less than 4% of total health-care spending, but for a larger percentage of patient spending. American patients paid 44.2% of dental expenses in 2007, compared to 10.3% for doctors, 3.33% for hospitalization, and 26.8% for nursing care.
This is mostly owing to the coverage’s nature. Dental coverage is a low priority for private businesses and the federal government when establishing benefit packages, particularly since the expense of providing medical insurance has soared. Employees face “cost sharing,” which implies expensive copayments even for those with “excellent” health coverage.
Approximately 10% of private dental coverage isn’t insurance at all, but rather a “discount plan” similar to Costco. Patients pay a membership fee and get a discount when they see a participating dentist. (Some contend that the remaining 90% does not meet the basic definition of insurance.) Dental expenses for low-income Americans participating in Medicaid are so cheap that many dentists refuse to treat them. As I previously said, except in a few unique cases, Medicare does not fund dental treatment.
In 2007, Americans paid 44.2% of dental expenditures out of pocket, compared to 10.3% for physicians, 3.3% for hospitalization, and 26.8% for nursing care. The American Dental Association sponsored an advertisement campaign in the 1950s to promote orthodontic treatment. Gradually, braces became an anticipated expense, like test prep and college tuition, as part of the cost of raising children. A straight, white smile is the clearest outward evidence of affluence, but dental insurance seldom covers orthodontia.
Having dental coverage is preferable than not having it, despite its numerous drawbacks. Per the National Association of Dental Plans, those 152 million Americans with dental insurance were 49% more likely to have had a checkup or cleaning in the previous six months, and 42% more likely to take their kids twice a year.
Like medical insurance, Americans now rely on their employment for dental care. Private dental coverage are obtaining by 97% of employees. 70% of the beneficiaries’ premiums or fees are funded by employers. 22% of businesses that provide dental insurance pay for the whole premium. Individual dental insurance is easier to get than individual medical insurance, but the cost is harder to justify due to long waiting periods and high copays.
The degree of patient control over whether, how, and when a dental condition is treating is a key medical-dental divide. When my dentist identified internal resorption as the source of my issues, he gave treatment alternatives that emphasized cost. Implant, bridge, or gaping hole were the options in decreasing order of cost. (That final option was never clearly expressed in real life.) It’s difficult to picture a doctor providing such a wide selection of options.
However, the fact that dental disorders, especially significant ones, are seldom medical crises requiring rapid treatment has their own set of downsides. One of the most important is that it helps patients to build a fake mental barrier between their mouth and the rest of their body. People are much more prone to overlook a dental condition than they are to overlook a medical concern. At least two of my acquaintances are now deferring root canals due to budgetary constraints. I doubt they would ask for a delay if a doctor told them they needed surgery. Of course, if they had medical insurance, a doctor’s order would almost always imply that the procedure would be cover.
Delaying dental care will not solve the issue. Quite the reverse, in fact. Dental caries and periodontal disease, according to Dr. Albert Guay, the American Dental Association’s top policy advisor, are “chronic, progressive, and destructive, and they get more severe with time.” When individuals ultimately seek treatment, the expenses are often greater than if they had gone to the dentist at the first sign of discomfort.
With its “health maintenance” philosophy, the medical profession has failed to emulate dentistry’s accomplishments in illness prevention. According to the American Dental Association, the average annual dental reimbursement is about $1,200-$1,500. In addition to saving money, the patient is financially rewarding for frequent dental visits and healthy eating habits.
Contrary to usual practice in health insurance, dental reimbursement levels tend to fall as complexity (and expense) increases. This is done to keep costs low and to encourage patients to brush, floss, see the dentist regularly, and eat well.
To safeguard the investment they (or their parents) have made in their mouths, I believe wealthy Americans are compelling to take good care of their teeth. According to Evelyn Ireland, the NADP’s executive director, less than 5% of those with dental insurance reach their yearly limit. The good news is that this is the case. The bad news is that if you’re one of the 5%, you’ll have to pay through the nose. Being an oral have-not in America is financially draining.
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