The High Cost of Fixing My Teeth

I am now the proud wearer of a new, all metal crown.  It covers the very last rear molar of my bottom teeth. So far back it can’t be seen when I smile. A poor little, worn-down tooth which once sported another crown.  Unfortunately it fell off years ago.  Probably didn’t cost enough.

This is not about teeth or – really --  fixing them.  It’s about the totally off-the-wall, totally outrageous cost to maintain an essential part of one’s body.

Hello Washington? I know you’re there – and probably eating your taxpayer-subsidized lunch somewhere with your taxpayer-subsidized, nicely filled and crowned teeth. 

So a quick reminder. Without teeth, people can’t eat.  If they can’t eat they get sick.  And before they die of starvation and malnutrition and fall out of the health care system – they can cost Washington, insurance companies and all of us who pay for things a great deal of money.

What set off this rant was the cost of repairing this one, afore-mentioned poor little worn-down tooth.  It started last April with the root canal, needed so my regular family-type dentist could build up the tooth enough with a core and post to hang a crown in place. Since I live in one of the most if not THE most medically expensive areas of our country – the root canal –performed by an endodontist who specializes in root canals - cost $1600.  Molars, should you not have had to find out, have four roots.

After a few months for my bank account to digest that, it was time for the crown. As I said it’s a metal crown. No room back there for the added heft of porcelain fused to the metal.  Doesn’t matter.  The cost, my dentist told me, was the same. $1250.  Add in the post and core, another $360.  Plus something called Intraoral-Periapical-First Film. An almost throwaway $32.  Total cost: $1614.

And grand total for the whole deal – root canal plus crown – a bank account draining $3214!

Now like most Americans, I don’t have dental insurance.  My union health coverage used to pay for $1000 worth of dental work a year.  That went bye-bye some years ago when medical costs began to soar. I could buy insurance myself but usually outside dental policies are so expensive and pay so little it’s not worth the effort. Even employees of giant companies with Cadillac health insurance usually get a measly $1500 worth of dental coverage annually.  At best it pays for cleaning and half the cost of a few filings and maybe a small, front tooth crown.  Medicare?  Foggedddaboudditt!

To get deadly serious for a moment, what do people do who CAN’T pull $3200 bucks out of their pocket? 

A number of recent studies have linked everything from heart disease and diabetes to Alzheimer’s Disease to poor dental health.  Our bodies are a closed system.  Each part connected to the rest of the parts.  As that old song “Dem (Dry) Bones” told us so many decades ago.

It makes absolutely no sense that dental health care isn’t simply part of the overall health care system. Included in our medical insurance of all kinds – private, Medicare and Medicaid.  As with so much of the mess that we call our health care system in the US --- we’re among the few highly developed economies without almost fully covered dental and medical care.

Therefore my bank account is now $3300 dollars smaller.  I don’t know what I might have done with all that money  -- fly to the moon and stay there perhaps -- but I do know that if I were a typical parent with my own tooth issues and kids who needed braces and such  – I’d probably be wishing they still made crowns out of gold – so I could pawn my mouth for next week’s groceries.

 

Getting Real: Wisconsin, Washington and Fixing America

It’s very hard to sit here outside the closed circle of America’s political posturers – elected, appointed and self-appointed – and not go ballistic.

We need to stop being Republicans and Democrats and Tea Partiers and Liberals -- and start rethinking everything. We need to look at what works in other countries and in some of our states. And just as important – what DOESN’T work. We have to change. Fast.

And ideologues need not apply.

The total US debt is moving toward 15 and a half TRILLION dollars. PIMCO’s Bill Gross has dumped all the treasuries he held in his benchmark Total Return Fund

So yes – the GOP is right. We DO have to pull back. But cutting all the funding for public broadcasting won’t help.

On the state level, according to State Budget Solutions, unfunded pension obligations now exceed 1 trillion dollars. The Congressional Budget Office projects Social Security will run dry by 2037. Medicare costs for everyone – recipients and taxpayers - are out of control.

I pay taxes just like most everyone else. So here’s what I think.

On the state level, I agree there need to be changes to public union medical and pension plans. But we don’t have to let Republicans destroy public unions (and the few private ones that are left). We all know the real reason for the Wisconsin collective bargaining farce.

That said -- remember most federal government workers don’t have collective bargaining – but most of us would be thrilled with their benefits. The benefit packages for public employees were originally created to make up for lower than private sector salaries. Well that’s long gone

So it’s time for states and union leaders to sit down and reason together. Look at salaries in both private and public sectors. Look at benefits. Average it all out. Relatively few taxpayers who aren’t working for government still have traditional pensions. And we pay a huge part of our own health insurance and medical costs. It may not be particularly civilized. But it’s reality.

It would be very, very unfair to cut pensions and raise medical costs unduly for workers who have already retired or who are within 5 years of retiring. They can’t recoup.

So let’s start with a cutoff age. Say 50. Everyone younger – including state and federal workers – should have to wait until at least 68 before collecting pensions, Social Security and Medicare. Maybe even 70 since we’re all, supposedly, living so much longer. Unless you’re medically unable to work. Now this doesn’t mean you’d HAVE to work until you hit 68. It just means you couldn’t collect any public retirement money till then. If you’ve saved enough to tide you over --- well just as always, you can “retire” whenever you can afford to. We also, however, need to strengthen our age discrimination laws and enforcement if we want people to work longer. Age discrimination is very hard to prove now and in the name of saving money companies routinely lay off the highest paid people. Who are often the oldest people.

We need to change completely how we pay for medical procedures and drugs under Medicare. Right now the government pays per item. Which encourages doctors who don’t think Medicare pays them enough to do every unnecessary test and procedure they can think of. Even during routine physicals. And patients are often prescribed expensive drugs because it’s quicker and easier than counseling them to change the behavior or lifestyle that’s causing the problem. Moreover we must, must, MUST get all medical records into digital form. Online so any doctor can see any patient’s total history. Because Medicare allows patients to choose their doctors and see as many as they wish, costs are often ratcheted up when someone goes from doctor to doctor until she gets the drug or procedure she wants. Regardless of necessity.

I’m no economist but logic suggests that just raising the age to get pensions and Medicare coverage - as well as reforming the way Medicare is structured - would probably keep the system solvent through at least another generation’s retirement. If not beyond.

If we’re going to ask or require Americans to finance more of their own retirement -- we also need to change the way money flows through the stock, options, and bond markets. High frequency and general electronic trading in huge blocks has made it very difficult for the small, retail investor - no matter how smart -- to do well in the market. You have to be on it every minute and still the block traders will set up their servers right next to those of the NYSE (for example) where their computer-programmed flash trades will overwhelm any individual trade you might try to make. Which leaves average Americans with just one choice beyond low-paying CD’s: put all your money in the hands of big fund managers. Many of them the same people who bought into the derivatives bubble which caused the financial crisis. Thank you – but no.

So if this crop of legislators and leaders and government agency managers won’t drop the posturing -- let’s have a giant recall election (kind of like a country-wide tag sale) and replace them all with pragmatists. Who will look at what DOES work and what CAN work and forget about which party comes up with the idea.

In other words – they’ll get real.

Whither Dental Insurance?

Good Grief Charlie Brown! I had oral surgery today – but that isn’t the news. The procedure is fairly common and with anesthesia – painless. I couldn’t face sitting with my mouth open for an hour while a surgeon performed micro-surgery on my uncooperative, failed-root-canal-tooth. Anesthesia didn’t change the mouth open part (and people who know me will probably say I never shut it anyhow). But I didn’t have to know what was going on or hear it. If dental surgery can ever be considered “comfortable” – this was it.

Until I had to pay for it.

I have some dental insurance in my plan. It pays only, however, for preventive measures – like teeth cleaning and necessary xrays before getting a tooth filled. It doesn’t pay for the filling. Or the crown. Or the oral surgery.

So as I was sitting in the recovery room holding ice to my gauze-stuffed cheek – the moment of truth arrived. My credit card (or more accurately my husband’s because I couldn’t get mine out with just one available hand; the other, you’ll remember, was holding the ice pak) was taken and the receipt returned.

$2100. And that didn’t included the $350 or so for the initial consultation and the panoramic xray needed to be sure my remaining 2 wisdom teeth - never to be touched without major jaw surgery – weren’t affected. The nice lady at Guardian said oh yes –that panoramic xray would have been eligible for the 75% reimbursement. Except that the plan only allows for one set of full-mouth xrays every 5 years. And I had a set back in ’09. Every 5 years???? Whose mouth stays the same for 5 years?????

Back to the $2100. It could have been $400 less if I had opted to stay awake and totally panicked for the surgery. I figured I could live without a few things for myself at Macy’s when I start my Christmas shopping. I needed that IV drip!!!

What do people do who need emergency dental procedures – and who aren’t as lucky as I am? Who simply don’t have that money? Maybe pay it off over 2 years? I didn’t see anything in the surgeon’s office about installment plans.

Why isn’t dentistry in general simply included with our regular health insurance plans? After all – you can get pretty sick and cost the health care system a pretty big chuck of change from a tooth or gum infection. In fact a bad tooth left untreated can do more than make you sick. It can kill you. Not having your teeth – or for that matter your eyes – tied into your regular health insurance makes absolutely no sense at all.

Until you talk to your dentist.

I asked mine and his answer was that the various dental associations –which ostensibly represent their members – don’t want the hassle of dealing with a broken insurance system. One that will cost each dentist additional time and money. Dentists would have to hire full time insurance clerks – the way physicians do. One of the reason group practices are so common. So the dentists deal with maybe one half-baked dental insurer --- which most of their patients don’t use even if they are lucky enough to have separate dental insurance. And they charge the rates they wish to charge without all the red tape medical doctors must deal with --- not the least of which involves Medicare and Medicaid.

So -- no pressure from dentists and oral surgeons to be included in the health insurance system. Or maybe pressure applied by their lobbyists in the other direction. As in “don’t you dare, Congressman so and so, to include us in that new health insurance law”.

As a result, I paid $2100 out of my own pocket today. And considered myself among the lucky ones.